All-Inside Versus Inside-Out Meniscus Repair: Gaps in the Long-Term Current Evidence

Meniscal repair has become the preferred treatment for many meniscal tears. As a result, multiple arthroscopic techniques have evolved, including the all-inside (AI) and inside-out (IO) approaches, which have been widely studied in the current literature. The present article highlights key limitations in studies reporting long-term outcomes (≥5 years), notably the heterogeneity of failure definitions and the lack of subgroup stratification by clinically relevant factors such as age, concomitant anterior cruciate ligament reconstruction (ACLR), and meniscal side (medial vs. lateral). To date, no clear superiority of the AI over the IO approach has been established. Redefining failure through multidimensional approaches that integrate structural, clinical, and patient-reported assessments will be crucial to ensure a consistent and patient-centered evaluation of repair success. Further research with robust subgroup analyses is needed to determine whether one technique confers superior long-term results in specific patient populations.