Outside-In Meniscal Repair: Contemporary Indications and Surgical Technique.

purpose of reviewMeniscus repair has become an important tool for managing meniscal tears due to the essential role each meniscus plays in load distribution, shock absorption, and joint stability. Repair is now favored whenever tissue quality and tear morphology are appropriate and this is supported by strong evidence highlighting the long-term adverse consequences of meniscectomy. Different meniscus repair techniques are available including all-inside, inside-out, and outside in. The purpose of this review is to outline the current clinical role of the outside-in meniscus repair technique, emphasizing its indications and technical considerations. RECENT

findingsRecent literature demonstrates a pronounced shift toward preservation-based management of meniscal tears, supported by robust biomechanical evidence indicating that even limited disruptions of circumferential fibers or meniscal root integrity markedly elevate tibiofemoral contact pressures and potentiate degenerative cartilage changes. Clinical outcomes studies consistently report increased utilization of meniscal repair and a corresponding decline in partial meniscectomy. Moreover, Systematic reviews have confirmed the superior long-term cost-effectiveness and functional outcomes associated with repair. Within this framework of expanding repair indications, advancement in suture-passing instrumentation has enhanced the precision, reproducibility, and efficiency of meniscus repair in general as well as the outside-in technique. The outside-in technique provides reliable access to anterior horn and body meniscus tears and affords secure fixation during meniscal allograft transplantation, thereby establishing it as an essential component of contemporary meniscal preservation techniques. The outside-in technique remains a valuable and cost-effective option, particularly for tears involving the anterior horn and mid-body of the meniscus, where access with all-inside devices may be limited. This method provides reliable fixation and accommodates a range of tear configurations. Although technically demanding for less-experienced surgeons and necessitating an additional skin incision, clinical outcomes remain favorable, with recent reports demonstrates low failure rates and significant functional improvement. As surgeon experience and technical refinement continue to progress, the outside-in technique further established its role as a fundamental tool in comprehensive meniscal preservation strategies.