Background: A “ramp lesion” is described as an injury involving the peripheral attachment of the posterior horn of the medial meniscus. Ramp lesions are associated with increased loads on anterior cruciate ligament and leads to rotatory instability of knee. During anterior cruciate ligament reconstruction, failure to identify and treat ramp lesion leads to increased forces on the reconstructed graft and residual instability which ultimately increases chances for graft failure. It is important to identify the ramp lesions by looking at the posterior compartment and repair ramp lesion. Ramp lesions are still a challenge to treat due to misdiagnosis and long learning curve of current techniques. In this technique, we are presenting margin convergence shoelace technique to repair a large ramp lesion. Indications: Isolated ramp lesions or ramp lesions associated with other ligamentous injuries. Technique Description: Through standard anteromedial and anterolateral portals, diagnostic arthroscopy is done. Using Gillquist maneuver, posteromedial compartment is visualized to look for ramp lesion. Probing is done with 18-gauge spinal needle from posteromedial aspect of knee to look for hidden lesions and extent of tear. We use 2 additional portals, low and high posteromedial portals for ramp repair. Visualizing from anterolateral portal entry is made in the posteromedial compartment; low posteromedial portal is created at the level of meniscus; 8-mm passport cannula is inserted and used as working portal; and then, high posteromedial portal is created and used as viewing portal. Visualizing through high posteromedial portal rasping of ramp lesion is done. Now with knee scorpion loaded with 2-0 fiber wire, bites are taken along posterior margin of meniscus and capsular portion of tear edges alternatively in shoelace manner from lateral to medial. Finally, compression and knot tying are done and secured with multiple half hitches. Results: Surgical repair of ramp lesions is associated with good healing, and it restores stability of knee. Follow-up of more than 2 years shows better functional outcome and reduced retear rates. Discussion/Conclusion: Currently, there are a lot of techniques described for ramp repair. We present arthroscopic ramp repair with dual posteromedial portals by shoelace technique, which is a safe, easy, and cost-effective method and gives excellent results and good healing especially in larger tears. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

<p class="abstract"><strong>Background:</strong> The aim of the study was to study the clinical outcome and complications of surgical management of intra-articular fractures of distal humerus.</p><p class="abstract"><strong>Methods:</strong> A prospective study included 23 consented patients with intra-articular distal humeral fractures who underwent osteosynthesis by orthogonal locking compression plating using posterior approach with olecranon osteotomy between November 2017 to May 2019 at BLDE(DU’s) Shri BM Patil Medical College, Vijayapura, Karnataka.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study there were 15 male patients and 8 female patients with mean age of 38.5 years. 65.2% of the cases admitted were due to motor vehicle accident, 21.7% due to accidental fall and 13% due to fall from height with right side (73.9%) being the more commonly affected side. The mean operative time was 100 minutes. Mayo Elbow Performance Score was 83.3% post operatively and the mean arc of motion was 117°. 82% of cases fared excellent to good results.</p><p class="abstract"><strong>Conclusions:</strong> Orthogonal locking plate construct provides stable rigid fixation for allowing early mobilisation and allows predictable healing both clinically and functionally in these complicated fractures. Absence of implant failure and non-union may be attributed to the highly stable construct system achieved by orthogonal locking plating. Majority of our cases had good functional outcome and return to pre injury status.</p>