5 comparative studies involving 901 patients with medial meniscus ramp lesions undergoing anterior cruciate ligament (ACL) reconstruction were included in this systematic review and meta-analysis comparing all-inside anterior portal repair vs posteromedial suture hook repair. Pooled outcomes included overall failure rates, isolated secondary meniscectomy, isolated ACL graft failure, knee stability measures, reoperation rates, revision surgery, and patient-reported functional outcomes. The pooled analysis demonstrated significantly higher overall failure rates and higher rates of secondary meniscectomy with the all-inside anterior portal technique, while ACL graft failure rates were similar between techniques. The findings suggest that posteromedial suture hook repair provides a more durable repair and may better restore native capsulomeniscal anatomy.