Classification and Surgical Repair of Ramp Lesions of the Medial Meniscus  Mathieu Thaunat, M.D., Jean Marie Fayard, M.D., Tales M. Guimaraes, M.D., Nicolas Jan, M.D., Colin G. Murphy, M.D., Bertrand Sonnery-Cottet, M.D.  Arthroscopy Techniques  Volume 5, Issue 4, Pages e871-e875 (August 2016) DOI: 10.1016/j.eats.2016.04.009 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 The patient is positioned supine on the operating table with a tourniquet placed high on the thigh. The knee is placed at 90° of flexion with a foot support to allow for a full range of knee motion. Arthroscopy Techniques 2016 5, e871-e875DOI: (10.1016/j.eats.2016.04.009) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Trans-notch maneuver for posteromedial compartment exploration. (A) The arthroscope is introduced through the anterolateral portal in the triangle limited by the medial condyle. (B) The arthroscope can pass through the space at the condyle border when one is applying a valgus force first in extension and then in flexion. (MFC, medial femoral condyle; PCL, posterior cruciate ligament.) Arthroscopy Techniques 2016 5, e871-e875DOI: (10.1016/j.eats.2016.04.009) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) Our proposed classification for medial meniscocapsular tears. (B) Type 1: meniscocapsular lesions. These lesions are very peripherally located in the synovial sheath. Mobility at probing is very low. (C) Type 2: partial superior lesions. These lesions are stable and can be diagnosed only by a trans-notch approach. Mobility at probing is low. (D) Type 3: partial inferior or hidden lesions. The lesions are not visible with the trans-notch approach but may be strongly suspected when there is significant mobility at probing. (E) Type 4: complete tear in red-red zone. Mobility at probing is very high. (F) Type 5: double tear. Arthroscopy Techniques 2016 5, e871-e875DOI: (10.1016/j.eats.2016.04.009) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 (A) Transillumination is used to facilitate needle placement and allows the surgeon to observe the veins and nerves that must be avoided. (B) The point where the needle is introduced is above the hamstring tendon, 1 cm posterior to the medial femorotibial joint line. (IPMM, inner portion of medial meniscus; OPMM, outer portion of medial meniscus; PMC, posteromedial capsule.) Arthroscopy Techniques 2016 5, e871-e875DOI: (10.1016/j.eats.2016.04.009) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Suturing of the posterior segment of the medial meniscus in a right knee through a posteromedial portal with a suture hook device (25° SutureLasso loaded with No. 1 PDS). (A) The meniscal lesion is debrided with a shaver introduced through the posteromedial portal. (B) The sharp tip of the suture hook penetrates the peripheral wall of the medial meniscus from outside to inside and emerges in the middle of the lesion's edges. (C) The suture hook is passed through the central part (inner portion) of the medial meniscus. (D) The first knot is tied with a knot pusher. (E) An arthroscopic suture cutter is used to cut the suture limbs. (F) The quality of the final repair is checked with a probe. (IPMM, inner portion of medial meniscus; MFC, medial femoral condyle; OPMM, outer portion of medial meniscus; PMC, posteromedial capsule.) Arthroscopy Techniques 2016 5, e871-e875DOI: (10.1016/j.eats.2016.04.009) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions