All-Inside Anterior Portal Versus Posteromedial Suture Hook Repair for Medial Meniscus Ramp Lesions: A Systematic Review And Meta-Analysis
A.C. De Albuquerque, R.A.S. Conde, A.G.M. Da Silva, R.G. Gobbi, C.P. Helito, D.P. LealObjectives:
To compare failure rates and clinical outcomes between all-inside anterior portal and posteromedial suture hook repairs for medial meniscus ramp lesions.
Methods:
A PRISMA-compliant meta-analysis was performed using PubMed, Embase, and Cochrane Library databases. Eligible studies enrolled (P) patients undergoing ACL reconstruction with a concomitant ramp lesion of the medial meniscus, comparing (I) all-inside repair through anterior portal with (C) posteromedial suture hook repair. Outcomes of interest (O) included ramp lesion healing or failure rates, reoperation or revision surgery, knee stability metrics, and patient-reported functional outcomes. Odds ratios (OR) with 95% confidence intervals (CIs) were pooled using random-effects models based on heterogeneity (I²).
Results:
Four studies comprising 823 patients were included. Pooled analysis revealed a significantly higher overall failure rate for the all-inside anterior portal technique compared to the posteromedial suture hook repair (OR 2.52; 95% CI 1.14–5.60; p=0.002; I²=56%). Specifically, the risk of secondary meniscectomy was substantially higher with the anterior portal approach (OR 2.83; 95% CI 1.59–5.03; p=0.0004; I²=28%).
Conclusion:
The all-inside anterior portal technique for ramp lesion repair is associated with significantly higher failure and reoperation rates compared to the posteromedial suture hook approach. Although the all-inside technique is technically simpler and avoids an accessory portal, it may fail to adequately restore capsulomeniscal anatomy, compromising repair durability. These findings suggest that the suture hook technique via a posteromedial portal is preferable for achieving stable, long-term healing. Further high-quality studies are warranted to optimize surgical indications.