From incision to outcomes: a comparative dive into the functional outcomes of arthroscopic all-inside and outside in meniscal repair techniques


  • Ashu Malhotra Department of Arthroscopy, Sant Parmanand Hospital, New Delhi, Delhi, India
  • Shekhar Srivastav Department Orthopaedics, Sant Parmanand Hospital, New Delhi, Delhi, India
  • Harjoban Singh Department Orthopaedics, Sant Parmanand Hospital, New Delhi, Delhi, India
  • Biswarup Sen Department Orthopaedics, Sant Parmanand Hospital, New Delhi, Delhi, India



Meniscal tear, Meniscal repair, Tegner Lysholm score, International knee documentation committee score


Background: Meniscal repair has been associated with superior outcomes, including enhanced knee function, increased activity levels, reduced osteoarthritis progression, cost savings, and improved long-term functional outcome scores compared to partial meniscectomy. This study aimed to evaluate and compare the functional outcomes of meniscal repairs performed using the outside-in and all-inside techniques, utilizing the International Knee Documentation Committee (IKDC), Tegner Lysholm (TL) scores and comparing our results with previous studies.

Methods: This prospective study included 53 patients with traumatic meniscal tears and associated ligamentous injuries that underwent arthroscopic meniscal repair. Details of investigations were recorded, and knee functional assessment was performed using the 2000 IKDC score and TL scores.

Results: The mean age of the patients was 28±8.41 years, with 41 (77.36%) males and 12 (22.64%) females. At the final follow-up of 1 year, the IKDC scores in the all-inside group and outside in group were 93.26±4.45 and 94.31±2.63. The TL scores in the all-inside and outside in groups were 95.33±2.45 and 96±1.00. No statistically significant difference was noted between the two groups (p value >0.005).

Conclusions: Meniscal repairs in the two groups in our series demonstrated favourable clinical outcomes, as evidenced by significant improvements in IKDC score with averages increasing from 25.31 to 93.26 and from 25.91 to 94.31 in all-inside and outside-in groups respectively. The TL sores showed an improvement from 21.07 to 95.33 and from22.43 to 96.00 in all-inside and outside-in groups respectively. In conclusion, short-term results of traumatic meniscal tears with repair are promising, leading to significant improvements in knee function irrespective of concomitant injuries and the type of repair.


Makris EA, Hadidi P, Athanasiou KA. The knee meniscus: structure–function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials. 2011;32(30):7411-31.

Bhan K. Meniscal tears: current understanding, diagnosis, and management. Cureus. 2020;12(6).

Nakayama H, Kanto R, Kambara S, Kurosaka K, Onishi S, Yoshiya S, et al. Clinical outcome of meniscus repair for isolated meniscus tear in athletes. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2017;10:4-7.

Fox AJ, Bedi A, Rodeo SA. The basic science of human knee menisci: structure, composition, and function. Sports Health. 2012;4(4):340-51.

Xu C, Zhao J. A meta-analysis comparing meniscal repair with meniscectomy in the treatment of meniscal tears: the more meniscus, the better outcome? Knee Surg Sports Traumatol Arthrosc. 2015;23(1):164-70.

Feeley BT, Liu S, Garner AM, Zhang AL, Pietzsch JB. The cost-effectiveness of meniscal repair versus partial meniscectomy: A model-based projection for the United States. The Knee. 2016;23(4):674-80.

Woodmass JM, LaPrade RF, Sgaglione NA, Nakamura N, Krych AJ. Meniscal repair: reconsidering indications, techniques, and biologic augmentation. JBJS. 2017;99(14):1222-31.

Cuéllar A, Cuéllar R, Heredia JD, Cuéllar A, García-Alonso I, Ruiz-Ibán MA. The all-inside meniscal repair technique has less risk of injury to the lateral geniculate artery than the inside-out repair technique when suturing the lateral meniscus. Knee Surg Sports Traumatol Arthrosc. 2018;26(3):793-8.

Chen NC, Martin SD, Gill TJ. Risk to the lateral geniculate artery during arthroscopic lateral meniscal suture passage. Arthroscopy. 2007;23(6):642-6.

Cho JH. A modified outside-in suture technique for repair of the middle segment of the meniscus using a spinal needle. Knee Surg Relat Res. 2014;26(1):43-7.

Snoeker BA, Bakker EW, Kegel CA, Lucas C. Risk factors for meniscal tears: a systematic review including meta-analysis. J Orthop Sports Physical Therapy. 2013;43(6):352-67.

Logan M, Watts M, Owen J, Myers P. Meniscal repair in the elite athlete: results of 45 repairs with a minimum 5-year follow-up. Am J Sports Med. 2009;37(6):1131-4.

Tengrootenhuysen M, Meermans G, Pittoors K, Van Riet R, Victor J. Long-term outcome after meniscal repair. Knee Surg Sports Traumatol Arthrosc. 2011;19(2):236-41.

Smith BE, Thacker D, Crewesmith A, Hall M. Special tests for assessing meniscal tears within the knee: a systematic review and meta-analysis. BMJ Evid-Based Med. 2015;20(3):88-97.

Pathak S, Bharadwaj A, Patil P, Raut S, Srikanth RV. Functional outcomes of arthroscopic combined anterior cruciate ligament reconstruction and meniscal repair: a retrospective analysis. Arthrosc Sports Med Rehab. 2020;2(2):e71-6.

Khajotia BL, Chauhan S, Sethia R, Chopra BL. Functional outcome of arthroscopic reconstruction of anterior cruciate ligament tear using peroneus longus tendon autograft. Int J Res Orthop. 2018;4(6):898-903.

Skou ST, Pihl K, Nissen N, Jørgensen U, Thorlund JB. Patient-reported symptoms and changes up to 1 year after meniscal surgery: An observational cohort study of 641 adult patients with a meniscal tear. Acta Orthopaedica. 2018;89(3):336-44.

Elmallah R, Jones LC, Malloch L, Barrett GR. A meta-analysis of arthroscopic meniscal repair: inside-out versus outside-in versus all-inside techniques. J Knee Surg. 2019;32(08):750-7.

Rathava DP, Maru DN, Patel DK. Clinical and functional outcome of different modalities of meniscus repair. Int J Orthop Sci. 2021;7(4):42-5.

Singh SP, Singh M, Singh PV, Singh S, Arif M. Functional outcome of arthroscopic meniscal repair in meniscal tears: a prospective study in tertiary care hospital in North India. Int J Res Orthop. 2021;7(4):816-9.

Austin KS, Sherman OH. Complications of arthroscopic meniscal repair. Am J Sports Med. 1990;21:864-9.

Stone RG, Frewin PR, Gonzales S. Long-term assessment of arthroscopic meniscus repair: a two-to six-year follow-up study. Arthroscopy. 1990;6(2):73-8.






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