Meniscal cyst formation was reported after meniscus repair, and the incidence was 1.7%–40.0%, especially after all-inside repair. The author's preferred technique in terms of location is the inside-out technique for middle and posterior based tears, the outside-in technique for anterior tears and the all-inside for tears isolated to the posterior horn. Saphenous nerve injury for MM repair and peroneal nerve injury for LM repair should also be avoided when using the inside-out technique. Care should be taken not to injure neurovascular structures mainly while repairing posterior horn/root of the LM using all-inside devices. The surgical technique of approach for meniscal repair can be divided into three procedures: inside-out, outside-in and all-inside technique, where a technique be applied depending on the location and type of meniscus injury. However, a good indication of meniscal repair had been historically limited to the longitudinal tear within the vascular area of the meniscus. However, further research would be necessary to validate the efficacy of these specialised technique. In summary, improved repair techniques and biological augmentation have made meniscus repair more appealing to treat that had previously been considered irreparable. Advancements in biological augmentation such as bone marrow stimulation, fibrin clot, platelet-rich plasma, stem cell therapy and scaffolds have also expanded the indications for meniscus surgery. When malalignment of the lower leg is accompanied with meniscus pathologies, knee osteotomies are a reasonable option to protect the repaired meniscus by unloading the pathological compartment. Long-term clinical outcomes of this procedure may change the strategy of treating meniscus extrusion. The centralisation techniques have been proposed to reduce the meniscus extrusion by suturing the meniscus-capsule complex to the edge of the tibial plateau. Recently, meniscus extrusion has attracted attention due to increased interest in early osteoarthritis. For symptomatic meniscus defects after meniscectomy, transplantation of allograft or collagen meniscus implant may be indicated, and acceptable clinical results have been obtained. Meniscal root tears substantially affect meniscal hoop function and accelerate cartilage degeneration therefore, meniscus root repair is necessary to prevent the progression of osteoarthritis change. Surgical decision-making depends on the type, size and location of the meniscus injury. Techniques for meniscal repair include ‘inside-out’, ‘outside-in’ and ‘all-inside’ strategies. Longitudinal vertical tears in the peripheral third are considered the ‘gold standard’ indication in terms of meniscus healing. Meanwhile, it spreads today as the development of the concept to preserve the meniscus and the improvement of meniscal repair techniques. In the past, the indication of a meniscal repair was limited both because of technical reasons and due to the localised vascularity of the meniscus. Although reoperation rates are higher after meniscal repair compared with arthroscopic partial meniscectomy, long-term follow-up of meniscal repair demonstrated better clinical outcomes and less severe degenerative changes of osteoarthritis compared with partial meniscectomy. To preserve the meniscal functions, meniscal repair should be considered as the first option for meniscus injury. Meniscus injury or meniscectomy results in decreased function of the meniscus and increased risk of knee osteoarthritis. The meniscus is important for load distribution, shock absorption and stability of the knee joint.
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