What question did this study set out to answer?

This commentary aims to evaluate the importance of posterior visualization in ramp repair during anterior cruciate ligament reconstruction.

March 26, 2026

Editorial Commentary : Posterior Visualization in Ramp Repair: The Only Path to True Healing

Key Points

This commentary aims to evaluate the importance of posterior visualization in ramp repair during anterior cruciate ligament reconstruction.
Analyzed surgical techniques for meniscocapsular lesions over two decades.
Reviewed biomechanical and clinical evidence supporting posterior approach.
Compared healing rates between posterior and anterior techniques.
Posterior visualization shows nearly double the healing rates compared to anterior all-inside techniques.
Significantly fewer secondary meniscectomies occur with posterior approaches.
Establishes posterior visualization as the gold standard for anatomic ramp repair.

Abstract

In the past 2 decades, posteromedial ramp repair for meniscocapsular lesions has transitioned from a challenging surgical technique to a vital element of anterior cruciate ligament reconstruction. Emerging biomechanical and clinical evidence underscores the posterior approach as the sole method offering direct visualization and effective engagement of meniscotibial structures. This technique enables precise debridement, stable fixation, and enhanced biological healing. Comparative studies reveal nearly double the healing rates and significantly fewer secondary meniscectomies with posterior visualization compared with anterior all-inside techniques. Consequently, posterior visualization is now the gold standard for anatomic ramp repair and a cornerstone of contemporary anterior cruciate ligament surgery.

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