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Objectives and questions: Low-grade posterolateral corner (PLC) injuries are frequently associated with lateral meniscus instability and may result in persistent pain and rotational symptoms, despite subtle imaging findings. The aim of this study was to evaluate the clinical outcomes of a standardized all-inside arthroscopic repair for isolated Grade I–II PLC injuries with lateral meniscus instability and to compare popliteus-including versus popliteus-sparing constructs.

Material and methods: Patients with isolated low-grade PLC injury and arthroscopically confirmed lateral meniscus instability were retrospectively reviewed. All patients underwent a standardized all-inside arthroscopic repair stabilizing the lateral meniscus at the popliteus hiatus. Clinical assessment was performed preoperatively and postoperatively and included varus stress test, dial test, posterolateral drawer test, grinding maneuver, and McMurray test. Patient-reported outcomes included the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Tegner Activity Scale, visual analog scale (VAS) for pain, and patient acceptable symptom state (PASS). Failure was defined as the combined occurrence of revision surgery and a negative PASS response. Minimum follow-up was 24 months. Patients were then stratified into two groups according to the repair construct: popliteus-including (P+) or popliteus-sparing (P–).

Results: Ninety-two patients (mean age: 25.4±6.8 years) were included in this study. Significant improvements were observed in all patient-reported outcome measures and clinical stability tests at final follow-up: IKDC increased from 39±5 to 85±4 and Tegner Activity Scale increased from 3±1 to 7±2 (all p < 0.001). VAS score improved from 6±2 to 1±1, with a positive PASS reported by 97% of patients. Return to sport was achieved in 90% of cases. Failure occurred in 3 patients (3.9%) and was associated with reinjury or non-adherence to the rehabilitation protocol. No statistically significant differences were observed between popliteus-including and popliteus-sparing constructs in terms of clinical stability, patient-reported outcomes, return to sport, or failure rates.

Discussion and conclusions: All-inside arthroscopic repair of lateral meniscus instability associated with isolated low-grade PLC injury provides reliable clinical improvement, high return-to-sport rates, and low revision rates at mid-term follow-up. Incorporation of the popliteus tendon did not confer additional clinical benefit compared with popliteus-sparing repair, supporting a tailored surgical strategy based on intraoperative findings.