Comparison of All-Inside Suture Implant Versus Suture Hook Technique for Meniscal Ramp Lesions: A Systematic Review and Meta-analysis

Background: Ramp lesions, tears at the posteromedial meniscocapsular junction, often accompany anterior cruciate ligament injuries and compromise stability. The all-inside repair is gaining popularity for its minimally invasive approach, though comparative data with suture hook (SH) repair remain limited. Purpose: To compare clinical outcomes of all-inside suture implant (SI) versus SH repair technique for ramp lesions. Study Design: Systematic review; Level of evidence, 3. Methods: A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided search of PubMed, EMBASE, Cochrane Library, and Google Scholar identified studies comparing all-inside SI versus SH repair for ramp lesions. Two reviewers independently screened, extracted data, and assessed quality with the Risk Of Bias in Non-Randomized Studies–of Interventions. Pooled mean differences and odds ratios (ORs) were calculated, with heterogeneity evaluated by Q-test and I 2 , applying random-effects models when appropriate. Results: Five studies (2 case-control and 3 cohorts) with 901 patients were included; 388 underwent all-inside SI repair. The mean age was 28.71 years, with follow-up ranging from 12 to 24 months. There was a significant difference in overall repair failure between groups, with 99 failures out of 388 cases (25.5%) in the all-inside SI group compared with 55 failures out of 513 cases (10.7%) in the SH group (OR, 2.36; P 7 mm and age ≤20 years did not significantly affect failure risk. Conclusion: SI repair for ramp lesions shows higher failure and secondary meniscectomy rates than SH repair. Functional outcomes appear largely comparable between the 2 repair techniques. Results should be interpreted cautiously, as outcomes depend on surgical technique, visualization, suture configuration, and rehabilitation. More high-quality studies are needed to define the optimal repair method.