Good Outcomes at 10 Years Reported for All-Inside vs. Inside-Out Meniscal Repair

A second-generation, “all-inside” meniscal repair system has a high success rate at long-term follow-up, according to a study from Vanderbilt University Medical Center in Nashville.

“Our 10-year results of second-generation, all-inside repair were better than those of first-generation implants and equivalent to those seen with the other common techniques,” the authors write in their report, which has been published online ahead of print by The Journal of Bone & Joint Surgery.

All-inside meniscal repair with second-generation devices has become the most common approach to treating this orthopaedic injury. Previous reports suggest similar 5-year outcomes with older inside-out techniques and current all-inside techniques, with failure rates of 14.2% and 15.8%, respectively.

However, few studies have presented 10-year follow-up data on the outcomes of second-generation, all-inside techniques. “We hypothesized that all-inside repairs that have demonstrated good results at [5] years would maintain their reasonable outcomes beyond 10 years and remain equally successful compared with inside-out repairs,” the study authors write.

Study Methods and Findings

The researchers analyzed the long-term outcomes of patients who had undergone meniscal repair using a second-generation, minimally invasive, all-inside repair system (FAST-FIX 360 Meniscal Repair System, Smith & Nephew) between 2002 and 2008. All patients underwent primary repair of a torn meniscus in conjunction with anterior cruciate ligament (ACL) reconstruction.

Of 81 treated patients, 69 were available for follow-up at 10 years postoperatively, including 40 male and 29 female patients with an average age of 26.5 years. The medial meniscus was repaired in 73% of patients and the lateral meniscus in 27% of patients. The main outcome of interest was the successful repair rate, defined as not undergoing subsequent surgery related to the meniscus during follow-up.

By this definition, the failure rate was 13% overall (9 repairs), with 12% for medial and 16% for lateral meniscal repairs (6 of 50 and 3 of 19, respectively). The average time to failure was 2.8 years for the medial repairs and 5.8 years for the lateral repairs (range, 1.2 to 5.6 years and 4.2 to 7.0 years, respectively; P = 0.002). Risk of failure was unrelated to patient and surgical characteristics such as age, sex, body mass index, graft type, and number of sutures.

Patient-reported outcomes – Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) score – were significantly improved after meniscal repair and ACL reconstruction compared with preoperative baseline measurements (P < 0.001). Both at the time of surgery and at long-term follow-up, these outcomes were similar for patients with successful versus failed repairs. Activity level was significantly lower at 10-year follow-up, consistent with previously reported age-related decreases.

“A Reasonable Approach”

The study provides new evidence that all-inside meniscal repair using this particular second-generation repair system with concomitant ACL reconstruction, “is a reasonable approach with good long-term results,” the study authors write. “In our series, 84% to 88% of the patients had continued success at a minimum of 10 years after the repair.”

For reasons that are unclear, treatment failure seemed to occur earlier following medial repair than following lateral meniscal repair. The researchers emphasize the need for “long-term follow-up…to adequately assess meniscal repair.”


Wright RW, Huston LJ, Haas AK. Ten-year outcomes of second-generation, all-inside meniscal repair in the setting of ACL reconstruction. J Bone Joint Surg Am. 2023 Jun 21;105(12):908-914. doi: 10.2106/JBJS.22.01196. Epub 2023 Jun 21.

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