The inside-out meniscal repair is linked with the prominent risk of neurovascular injury, and therefore the procedure needs a safety incision. The study focuses on finding a way, through which meniscal repair can be done efficiently, without any adverse effects and a safety incision.

There is a considerable risk of injury to neurovascular structures during the inside-out meniscal repair is executed in the deficit of safety incision; although, weak evidence are governing this risk. Investigators conducted a simulation analysis on archival MRI films to assess what risks a needle insertion exerts on the peroneal nerve and popliteal neurovascular bundle during the inside-out meniscus recovery without a “safety incision”, and to establish a “safe zone” of the menisci which can be reliably used for repairing by applying this approach.

Archival MRI scans were retrieved, and axial sections were utilised for simulation. The needle passage stimulation was done for lateral, medial menisci and posterior horn at “half-hour” intervals applying clock method of 15° intervals with two separate needle cannulas and three separate portals, appearing in six different plots of needle passage for each spot on the meniscus. The distance of the needle in every scenario was measured using the popliteal vessels and peroneal nerve. The negative means were discovered from “Mean + 3SD” and positive from “mean-3SD” value. An additional 2mm was considered to be the “safe distance”. Consequently, simulation models who showed the mean + 3SD greater than -2 mm or mean − 3SD less than 2 mm were marked as “unsafe”.

The passage of the needle through medial meniscus at and medial to 1 o’clock position for the right knee, regardless of the portal and needle type was viewed as safe. Moreover, if the lateral meniscus is employed, only the equatorial region was seen to be safe.

If performed via the popliteal neurovascular bundle, the inside-out medial meniscal repair is safe without a safety incision. The straight cannula and the AM portal should be evaded for the terminal-most part of the posterior horn. Moreover, this approach cannot be suggested without a safety incision for lateral meniscus because of the threat to the popliteal vessels and the peroneal nerve. The all-inside method or inside-out method with a safety incision should be chosen for lateral meniscus.