Meniscocapsular ramp lesions in the paediatric knee: A review of diagnosis and surgical management

Table 3 Comparison of all-inside and inside-out ramp repair techniques

Techniques	All-inside[38,39]	Inside-out[40]
Advantages	Less invasive, no posterior incision required, potentially faster surgical time	Allows for multiple sutures, more precisely placed sutures, in either vertical or oblique mattress patterns, providing superior compression. Lower risk of iatrogenic meniscal damage from smaller needles
Disadvantages	Device size may be cumbersome in smaller paediatric knees	Requires a separate posteromedial incision and carries a higher risk of injury to the saphenous nerve
	Larger needle bores can cause a “cheese-wire” effect on the meniscus, although no evidence in literature details this; effects may be amplified in the softer, more vascularized pediatric meniscus. Risk of anchor-related complications (synovitis, chondral damage)
Technical Considerations	Requires knee flexion and valgus force to open the medial compartment	Careful posteromedial portal creation with transillumination to identify the saphenous vessel (and therefore nerve), and blunt dissection/introduction
	Precise needle depth control to avoid over-penetration