Meniscal tear orientation and complexity must be considered in addition to location. Based on the blood supply pattern, tears in the vascular periphery of the meniscus have the best ability to heal, whereas tears in the central white-white zone demonstrate poorer healing rates and are less amenable to repair. DeHaven 16 classified tears in the peripheral 3 mm as vascular (also referred to as the red-red zone), tears greater than 5 mm from the meniscocapsular junction as avascular (white-white zone), and tears in between as variable (red-white zone). The popliteal hiatus also creates a relatively hypovascular area in the posterior horn of the lateral meniscus. Only the peripheral 10% to 30% of the meniscus is vascularized, supplied by the medial and lateral genicular arteries 6 the remaining meniscus must receive its nutrition through synovial fluid diffusion. Repair suitability is often determined during arthroscopy. Not all meniscus tears are amenable to repair, and several factors must be considered to determine repair suitability and healing potential. Despite their popularity, all-inside meniscal repairs must continue to be compared to inside-out repairs. 13, 47 All-inside techniques have been developed to reduce surgical time, technical difficulty, and risk to neurovascular structures. Success rates with inside-out techniques average 60% to 80% for isolated meniscal repairs and 90% in the setting of concurrent anterior cruciate ligament (ACL) reconstruction owing to the enhanced healing environment. The gold standard currently remains inside-out vertical mattress suture repairs. 5 Meniscal repair techniques have evolved over time, and they include open, outside-in, inside-out, and all-inside repairs. The concept of meniscal repair was first described by Annandale in 1885. 2, 3, 15, 20 The meniscus should therefore be preserved whenever possible. 21 The long-term consequences of total meniscectomy include the predictable development of degenerative changes in the joint. The meniscus contributes many key functions to the knee joint, including joint stability, 34 shock absorption and load transmission, 14 proprioception, 17 and articular cartilage nutrition. Meniscal repair has become a commonly performed procedure, particularly with the advent of all-inside meniscal repair devices and techniques.
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