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Different Regional Healing Rates with the Outside-In Technique for Meniscal Repair

Michiel F. van Trommel, MD^*,, Peter T. Simonian, MD^*, Hollis G. Potter, MD and Thomas L. Wickiewicz, MD^*

^* The Sports Medicine Service
MRI Division, The Hospital for Special Surgery, Affiliated with the New York Hospital-Cornell University Medical College, New York, New York

Address correspondence and reprint requests to Michiel F. van Trommel, MD, Onze Lieve Vrouwe Gasthuis, 1e Oosterparkstraat 279, 1091 HA Amsterdam, the Netherlands

Fifty-one patients with meniscal repair using the outside-in technique were reassessed with second-look arthroscopic procedures (N = 15), arthrographic examination (N = 41), magnetic resonance imaging (N = 36), or a combination of these techniques. Forty-one medial and 10 lateral menisci were repaired. The average clinical follow-up was 15 months (range, 3 to 80). Forty-five of 51 patients had tears that were located in or extended into the posterior horn of the medial or lateral meniscus. Complete healing occurred in 23 menisci (45%), partial healing was observed in 16 (15 medial, 1 lateral) (32%), and no healing occurred in 12 (24%). Remarkably, in all 15 patients who had tears extending from the posterior to the middle third of the medial meniscus that were partially healed, it was always the posterior third that had not fully healed. This finding is statistically significant. In addition, the middle third of these menisci had not fully healed in five patients. No healing occurred in the two patients with tears in the posterior third of the medial meniscus. Poor healing with the outside-in technique was observed in patients with tears into the posterior horn of the medial meniscus. For tears in the middle and anterior portion of the medial meniscus, as well as all lateral meniscus tears, the outside-in technique is our current method of choice.

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