Editorial Commentary: Various Meniscal Repair Techniques Show Similar Biomechanical and Clinical Outcomes, and Horizontal Suture Orientation Is Best Avoided

Knee meniscal repair shows favorable outcomes, especially if associated with anterior cruciate ligament reconstruction. However, a favorable clinical outcome does not mean that the meniscus has healed. There is no difference in clinical outcomes between all-inside and inside-out meniscal repair techniques. The all-inside technique is faster and associated with a lower incidence of neurovascular injuries. In terms of biomechanical studies, protocols vary, and no meniscal repair technique (all-inside, inside-out, or outside-in) is clearly superior to any other technique regarding tensile load, tissue failure rate, or restoration of contact mechanics. That said, a vertically oriented meniscal suture captures circumferential collagen bundles and is superior in strength to any horizontal meniscal stitch. A horizontal meniscal stitch orientation should be avoided.