Background: After inside out suture for lateral meniscal tear, the popliteal hiatus is closed. So that procedure is not anatomical. From 2003 we have done all inside anatomical meniscal suture without any implants. This procedure preserves popliteal hiatus.

Objective: To introduce the procedure of anatomical all inside lateral meniscal suture and evaluate post operative results.

Material and Method: From 2003 till 2008, we have done all inside lateral meniscal suture in 43 cases. Twenty eight were male and 15 were female. The age at operation was 9 to 42 (mean: 22). Simple meniscal tear were 21 cases, meniscal tear with ACL injury 17 cases, discoid meniscal tear 4cases, and loose meniscus 1 case. Three portals (lateral infra-patellar, medial infra-patellar, and mid para-patellar) were needed. For suturing torn meniscus, we always use spinal needle that was curved by operative surgeon, and sometimes use Caspari suture punch. After rasping torn part, through medial portal the curved spinal needle within non-absorbable thread was pierced to free margin side of lateral meniscus to be passes through torn part toward tibial side of popliteal hiatus. From mid para-patellar view, tip of spinal needle and thread were seen in popliteal hiatus. And only thread was picked up by punch forceps through lateral portal. This end was passed over lateral meniscus. Finally sliding knot was done. Forty cases were followed. Mean follow up period was 1 year and 11 months. The second look arthroscopy was done in 27 cases, 3 months to29 months (mean: 11 months) after meniscal suture.

Results: There were no complications during and after operation. The second look arthroscopy showed complete union in 16 cases, incomplete union in 7 cases and failure in 4 cases. Among the other cases, physical examination revealed failure in one case. Total success rate was 87.5%. This procedure is only the way for anatomical repair of torn lateral meniscus and post operative results are good.