Greater rate of return to play and re-injury following all-inside meniscal repair compared to the inside-out technique: a systematic review

Abstract

Introduction Inside-out and all-inside arthroscopic meniscal repairs are widely performed. However, it remains unclear which method promotes greater clinical outcomes. This study compared inside-out versus all-inside arthroscopic meniscal repair in terms of patient-reported outcome measures (PROMs), failures, return to play, and symptoms. Methods This systematic review was conducted in accordance with the PRISMA guidelines. Two authors independently performed the literature search by accessing the following databases: PubMed, Google Scholar, and Scopus in February 2023. All clinical studies which investigated the outcomes of all-inside and/or inside-out meniscal repair were considered. Results Data from 39 studies (1848 patients) were retrieved. The mean follow-up was 36.8 (9 to 120) months. The mean age of the patients was 25.8 ± 7.9 years. 28% (521 of 1848 patients) were women. No difference was found in PROMs: Tegner Activity Scale (P = 0.4), Lysholm score (P = 0.2), and International Knee Document Committee score (P = 0.4) among patients undergoing meniscal repair with all inside or inside-out techniques. All-inside repairs showed a greater rate of re-injury (P = 0.009) but also a greater rate of return to play at the pre-injury level (P = 0.0001). No difference was found in failures (P = 0.7), chronic pain (P = 0.05), reoperation (P = 0.1) between the two techniques. No difference was found in the rate of return to play (P = 0.5) and to daily activities (P = 0.1) between the two techniques. Conclusion Arthroscopic all-inside meniscal repair may be of special interest in patients with a particular interest in a fast return to sport, while, for less demanding patients, the inside-out suture technique may be recommended. High-quality comparative trials are required to validate these results in a clinical setting. Level of Evidence Level III, systematic review.

Rehabilitation and Return to Play of an Ice Hockey Athlete after Lateral Meniscus Repair: A Case Report

“…Long-term observational studies have demonstrated that 19% of meniscus repairs fail [29]. The surgical method applied for such repairs, the all-inside technique, has shown a higher probability of the player returning to the game after recovery to the pre-injury level than the inside-out technique; at the same time, the injury recurrence rate is higher [30]. In addition, osteoarthritis can occur secondarily to meniscus damage [31], making evaluation through re-measurement of functional aspects a necessity in follow-up studies to identify the negative effects of injuries and surgeries.…”

Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta‐analysis

“…Meniscal tears have different aetiologies and injury patterns [ 44 , 47 , 60 ]. First, a distinction is made between acute and degenerative tears [ 39 , 56 ]. Acute tears are commonly the result of trauma or sports injuries.…”