Clinical Outcomes of Inside-Out Meniscal Repair According to Anatomic Zone of the Meniscal Tear
Within the meniscus, three anatomical zones have been described based on varying levels of vascularity. The “red-red” zone is on the periphery of the meniscus and has been reported to be the most vascular, whereas the middle “red-white” and innermost “white-white” zones have progressively less vascularization. It is unclear how much these varying levels of blood supply affect each zone’s healing capacity following meniscal tears. In order to evaluate this question, outcomes following meniscal repair using an inside-out technique after lesions in all 3 meniscal vascularity zones were compared.
Results from patient completed surveys 2 years following surgery demonstrated improvements for all repairs regardless of vascular zone, but those with repairs in the “red-red” and “red-white” displayed improved outcomes compared to those with tears in the “white-white” zone. Patient reported outcomes also demonstrated higher scores for patients who underwent meniscal repair for a recent meniscal tear compared to a chronic, degenerative lesion. Furthermore, only 3.5% of all patients regardless of vascular zone required a second surgical procedure for a failed meniscal repair. Although worse outcomes were observed in the “white-white” zone relative to the others, inside-out meniscal repair is recommended for potentially reparable meniscal tears in all 3 vascular zones.