High failure rate after all‐inside revision meniscal repair: Female sex and absence of ACL reconstruction increase risk

PURPOSE: To determine the failure rate and identify factors associated with failure following all-inside revision meniscal repair in patients with persistent or recurrent symptoms after primary meniscal repair. METHODS: This was a retrospective cohort study including 108 consecutive patients who underwent arthroscopic all‑inside revision meniscal repair between 2015 and 2022 at Capio Artro Clinic, Stockholm, Sweden. Evaluated factors included demographic variables (age, sex), surgical variables (concomitant anterior cruciate ligament reconstruction [ACLR]) and tear-specific characteristics (tear morphology and meniscal laterality). Failure was defined as repeat surgery for the index tear. Patients were followed for up to 3 years. Survivorship was assessed using Kaplan-Meier analysis, and factors associated with failure were evaluated using multivariable Cox regression. RESULTS: Failure occurred in 54 of 108 repairs (50.0%) at a mean of 18.3 ± 16.0 months. In unadjusted analyses, tear morphology was associated with failure (p = 0.026), with radial and horizontal tears showing the highest failure proportions and longitudinal tears the lowest. In the adjusted Cox model, female sex (hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.36-4.95; p = 0.004) and absence of concomitant ACLR (HR 3.63, 95% CI 1.67-7.90; p = 0.001) were independently associated with failure. Age, meniscal laterality and tear morphology were not associated with adjusted survivorship. CONCLUSION: All-inside revision meniscal repair demonstrated a high failure rate of 50% at mid-term follow-up. Female sex and absence of concomitant ACLR were independently associated with an increased risk of failure. These findings highlight the importance of patient- and procedure-specific factors when considering revision meniscal repair as a tissue-preserving option. LEVEL OF EVIDENCE: Level III.