Medial Meniscal Ramp Lesion Repair Through Anterior Portals Using a Medial Collateral Ligament Pie-Crusting Technique

Ramp injury, that is, injury to the peripheral attachment of the posterior horn of the medial meniscus, often requires additional surgery during anterior cruciate ligament (ACL) reconstruction. Diagnosis and treatment of ramp lesions are important because unrepaired ramp lesions could cause risk to the reconstructed ACL because of anteroposterior and external rotation laxity, whereas acute rupture or chronic deficiency of the ACL could also cause ramp lesions because of instability. Ramp lesions are difficult to diagnose and treat from the anterior compartment during arthroscopy. Typically, this repair requires technically demanding skills and is performed from the posterior portal using a suture hook under visualization with the arthroscope through the intercondylar notch. Inexperienced surgeons often struggle with using the posterior portal and the suture hook. Our all-inside repair technique using the FasT-Fix system (Smith & Nephew, Andover, MA) under direct visualization from the anterior compartment accompanied by a medial collateral ligament pie-crusting technique facilitates repair of ramp lesions without causing medial instability.