半月板缝合技术的最新概念：适应证、优势与局限性
简介
本文系统综述了半月板缝合的三种核心技术——由内向外、由外向内和全内技术，详细描述了各自的步骤、适应症、优缺点及并发症。研究发现，尚无一种技术显示出明确的愈合或失败率优势，但全内技术可减少软组织剥离和手术时间，而ACL重建联合修复可通过改善稳定性和骨髓源性生物学增强促进愈合。临床选择需根据撕裂位置和患者因素个体化，并注意神经血管保护等操作要点。
英文摘要
The meniscus is critical for load distribution and joint stability; tears disrupt biomechanics and accelerate cartilage degeneration, prompting a shift from meniscectomy toward preservation and repair. We review three core techniques - inside-out, outside-in, and all-inside - with stepwise descriptions, indications, advantages/limitations, devices, and complication profiles. Inside-out offers precise, strong fixation but requires an accessory incision and neurovascular precautions; outside-in is reproducible and cost-efficient for anterior horn tears; and all-inside reduces soft-tissue dissection and operative time, improving access to posterior/body regions. No single meniscal repair technique demonstrates clear superiority in healing or failure rates; outcomes depend on tear characteristics and patient factors. Although modern all-suture all-inside devices show favorable biomechanics, their higher cost and unclear cost-effectiveness limit definitive clinical advantage. Technical pearls include optimized portal placement, peripheral bites, protection of neurovascular structures, and avoidance of soft-tissue bridges. Concomitant ACL reconstruction enhances healing - likely via improved stability and marrow-derived biologic augmentation. Region-specific guidance is provided using medial and lateral anatomical zoning, aligning suture patterns (inside-out, outside-in, and all-inside) to tear location to preserve biomechanics and reduce complications.