Miller Adam C, Batiste Alexis J, McQuivey Kade S, McCarty Eric C
Department of Sports Medicine and Knee Surgery, University of Colorado School of Medicine, Denver, Colorado, USA.
Orthop J Sports Med. 2025 Aug 12;13(8):23259671251361488. doi: 10.1177/23259671251361488. eCollection 2025 Aug.
Meniscal tears are a common knee injury in athletes, necessitating effective repair techniques. Despite the prevalence of meniscal tears, there is limited literature comparing the efficacy of the 2 primary suture methods-all-inside and inside-out-in the athletic population.
To evaluate the postoperative outcomes and failure rates of the all-inside versus inside-out suture techniques in meniscal repairs among athletes.
Systematic review; Level of evidence, 4.
Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was conducted across the PubMed, Cochrane, and Embase databases on July 26, 2023, yielding 245 studies, of which 7 were included in this review. Studies reporting postoperative outcomes and failure rates of both suture techniques were included. Failure was defined as the need for subsequent surgery due to a persistent meniscal tear. Outcome measures included the Tegner, Lysholm, and International Knee Documentation Committee scores. Differences between groups and subgroups were assessed using the Welch test and the odds ratio. Wilcoxon tests were used as a sensitivity analysis to confirm the results of the Welch tests. Heterogeneity was assessed with the statistic and the Bartlett test. All statistical analyses were done using R.
Seven studies-published between 2009 and 2023-met the inclusion criteria, including 469 operations in 458 patients. A total of 199 operations used the all-inside technique, and 270 operations used the inside-out technique. Of the 469 operations, 377 had documentation on laterality (medial meniscal repair versus lateral meniscal repair), with 167 patients undergoing medial meniscal repair and 210 patients undergoing lateral meniscal repair. Each all-inside repair was done with the Fast-Fix device. The all-inside technique showed a statistically significant increase in failure rate compared with the inside-out technique (23.1% vs 12.2%; = .003). This trend was exaggerated in all-inside repairs for the medial meniscus versus the lateral meniscus (58.1% vs 11.8%; = 2.6 × 10). When excluding all radial tears, the all-inside technique again had an increased rate of failure compared with the inside-out repairs (20.7% vs 8.3%; = .01). No significant difference was found in postoperative Tegner scores between all-inside and inside-out repairs (5.9 vs 6.5; = 0.45).
Our review demonstrated that medial meniscal repairs with the all-inside technique using the Fast-Fix device had a higher failure rate compared with those with the inside-out technique; this trend is not seen for lateral meniscal repairs. Based on the findings of this study, surgeons should consider the inside-out technique first for athletic patients presenting with medial meniscal tears who want to return to their sport. Given the limited scope of existing studies combined with more recent utilization of novel all-inside meniscal repair devices that may not be captured in the present study, additional high-quality, prospective studies in this area are needed to validate these findings.
半月板撕裂是运动员常见的膝关节损伤，需要有效的修复技术。尽管半月板撕裂很常见，但在运动员群体中，比较两种主要缝合方法——全内缝合和由内向外缝合——疗效的文献有限。
评估运动员半月板修复中全内缝合与由内向外缝合技术的术后结果和失败率。
系统评价；证据等级，4级。
按照PRISMA（系统评价和Meta分析的首选报告项目）指南，于2023年7月26日在PubMed、Cochrane和Embase数据库进行全面检索，共获得245项研究，其中7项纳入本评价。纳入报告两种缝合技术术后结果和失败率的研究。失败定义为因半月板持续撕裂而需要再次手术。结果指标包括Tegner、Lysholm和国际膝关节文献委员会评分。使用Welch检验和比值比评估组间及亚组间差异。采用Wilcoxon检验进行敏感性分析以确认Welch检验结果。用I²统计量和Bartlett检验评估异质性。所有统计分析均使用R软件完成。
7项研究（发表于2009年至2023年）符合纳入标准，包括458例患者的469例手术。共199例手术采用全内技术，270例手术采用由内向外技术。在469例手术中，377例有关于半月板侧别（内侧半月板修复与外侧半月板修复）的记录，其中167例患者接受内侧半月板修复，210例患者接受外侧半月板修复。每次全内修复均使用Fast-Fix装置。与由内向外技术相比，全内技术的失败率有统计学显著升高（23.1%对12.2%；P = 0.003）。在内侧半月板与外侧半月板的全内修复中，这种趋势更为明显（58.1%对11.8%；P = 2.6×10⁻⁵）。排除所有放射状撕裂后，与由内向外修复相比，全内技术的失败率再次升高（20.7%对8.3%；P = 0.01）。全内缝合与由内向外缝合术后Tegner评分无显著差异（5.9对6.5；P = 0.45）。
我们的评价表明，使用Fast-Fix装置的全内技术进行内侧半月板修复的失败率高于由内向外技术；外侧半月板修复未见此趋势。基于本研究结果，对于希望重返运动的内侧半月板撕裂的运动员患者，外科医生应首先考虑由内向外技术。鉴于现有研究范围有限，且结合本研究可能未涵盖的新型全内半月板修复装置的最新应用情况，该领域需要更多高质量的前瞻性研究来验证这些发现。
