Table 2.

Sequential Steps Inside-Out Meniscal Repair

Medial Repair	Notes
Diagnostic arthroscopy	Standard anterolateral and anteromedial portals
Granulation tissue debridement of tear	4.5-mm shaver
Posteromedial vertical incision	4 cm length, 2/3 distal, 1/3 proximal to the joint line
Dissection through the oblique sartorius fascia	Proximal to distal using Metzenbaum scissors
Retraction of sartorius, gracilis, semitendinosus	Protect the saphenous nerve
Placement of a popliteal retractor	Interval between the medial gastrocnemius and joint capsule
Suture cannula directed through the anterolateral portal	Valgus force, knee at 10° to 20° of flexion
Needle retrieval	Flex to 70° to 90°
Second needle placed adjacent to the first	Keep slight tension to avoid suture puncture/laceration
Continue suture placement posterior to anterior	Placement 3 to 5 mm apart
Cut needles and tag sutures with hemostat or tie immediately	Avoid overtensioning to prevent puckering
Thoroughly irrigate wound	–
Close in a standard layered fashion	–

Lateral Repair	Notes
Lateral vertical skin incision	2.5 to 4 cm, posterior to the FCL
Deep transverse oblique incision from posterior ITB to Gerdy's	Stay anterior to the biceps tendon to avoid the peroneal nerve
Superficial ITB incision 5 mm anterior to the posterior margin	Avoid injury to the FCL and deep lateral capsule
Placement of a retractor	Interval between the lateral gastrocnemius and joint capsule
Suture cannula directed through the anteromedial portal	Varus force, knee at 10° to 20° of flexion

FCL, fibular collateral ligament; ITB, iliotibial band.