Ramp lesions are meniscocapsular or meniscosynovial tears associated with chronic ACL injury and are postulated to occur because of disruption of meniscotibial ligament. Various techniques have been described in literature for their diagnosis and repair. Each of the described techniques have had some concerns. The authors, hereby, describe a novel technique for RAMP repair. Patient is positioned supine with the knee at 90 degrees with a side support. Standard arthroscopic portals are established. Ramp lesions are visualised through a trans-notch approach and probed simultaneously using an 18-guage needle posteromedialy. Once the diagnosis has been confirmed a posteromedial (PM) portal is established. The edges of the tear are freshened from the PM portal using a shaver or rasp. Knee Scorpion device (Arthrex) is then introduced through the PM which is loaded with No. 0 Fibrewire (Arthrex) in its lower jaw. The Scorpion device is deployed on the capsular side first, avoiding injury to the posterior structures and the suture loop is retrieved. Scorpion is loaded again with the other strand and is passed through the meniscal edge. A sliding knot is used. Ramp lesion is re-probed after tying a sliding knot for requirement of another suture. This technique provides us with an improved visualisation and diagnosis, better quality of debridement and complete closure of the ramp lesion using a simple suture device. In our experience this is a safe, successful and easily reproducible technique.Abstract
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