So, I'm going to talk about LAMP regions. So last year, I had the great chance to have excellent three traveling fellow and godfather in my institute. The LAMP region is most representative of the meniscus tail, which is related to the Asian injury. It is difficult to detect using anterior portal. Anterior visualization is necessary. This is viewed from the posterior media portal. You can see the median meniscus posterior was separated posterior capsule, that is LAMP region. So, Dr. Houston proposed the mechanism of LAMP region. The loss of ASIA function resulting in increased anterior tibial translation and meniscus was wedged between femur and tibia. At the same time, the semimembrane muscle contract along the posterior capsule. The LAMP region, the word firstly used by Dr. Strobel. Most of the relevant literature report meniscus LAMP region was firstly described by Dr. Strobel in 1988. But it was used the same LAMP region is called the vertical peripheral tail by the Swedish doctors. They visualized the posterior compartment, so-called the Gilchrist maneuver. They reported new tail and old tail and repair technique and clinical result. One year later, it was also called the reparable meniscus capsular disruption by the American doctor in 1984. They described detailed technique of astroscopic visualization of the meniscus capsular disruption. And LAMP region is highlighted by Jin Hwan-Won in South Korea 2004. This LAMP region was neither discussed nor the subjective research for almost two decades when it was eventually highlighted again by Dr. Ahn in South Korea in early 20s. I and Dr. Ahn reported repair technique and clinical result of LAMP region. This is editorial comment by the Roman Gile, the previous ESCA president. In ESCA Congress in Osaka 2007, he was lucky to see Jin Hwan-Won performing the impressionable complex astroscopic meniscus repair for the LAMP region. He followed his technique and he reported his case in French Astroscopic Society. And also it was followed by a visit in Luxembourg by Bertrand Sonnery-Cortet in Lyon, France. Sonnery-Cortet called LAMP region as a hidden region after systematic astroscopic exploration. I will show you the video. Trans-notch approach, astroscopy is advanced to the posterior medial compartment. That is called the Gilquest maneuver. Using trans-illumination technique, so I'm going now, and the posterior medial portal is being made. After then, there is a 30 degrees scope, 30 degree of scope provide limited view. So 70 degree of scope might be better. So LAMP region is proving. After then, the viewing portal is changed to the posterior medial part. The switching stick is used. Over the switching stick, sheath is inserted and scope is inserted. After then, we can clearly see the LAMP region through the posterior medial portal. We also see the vertical motion of tail. When knee is fractured and extension, there is big vertical motion. That's the reason we need the repair for the LAMP region. So you want here spontaneously. So viewing portal is changed. At that time, we use a 70 degree scope. 70 degree scope provide more view, so we use suture hole. Suture hole, suture tip poke the posterior capsule from top to bottom, and we can feel the puff. After then, rotate the tip, and tip is placed between the tibia, flat toe, and meniscus, and push it to inner side, and feel the end, and rotate. After then, PDS suture is advanced. There is a procedure of the suturing. After then, suture hole is removed. The other end of the suture is pulled out through the posterior medial portal. After then, there is possible soft tissue bridging between two suture, so it is necessary to pull out again. After then, essential sliding time is made. Suture is go underneath one suture, two suture and one suture, to go through the triangle side. Last loop is became a locking loop. By pulling left side, sliding loop is going inside the joint. After then, it is tightened again by pulling to end, and locking loop. By pulling the right side, the locking loop is going inside the joint, and it is locked. Three or four additional half-witches are applied to secure the knot. This process is repeated. The suture interval is five millimeter. Finally, we check the stability of the meniscus. So this is view from the posterior medial portal, and it is securely sutured, and there is an anatomic reduction of tail side. This is view from the intercontinental large view, 70-degree scope, and you can clearly see the tail side. I will show it. It is important, it is good to know the portal acts like a center of rotation. Big rotation of handle and shaft is converted to small rotation of suture tip. A big upward motion of handle is changed to small downward motion. There is two steps of capsular side and meniscus side. Poke the capsule from top to bottom, top to bottom, and we can feel the pop after the rotator tip, and advanced tip, and tip is located between tibial flutter and meniscus, and push inward, and feel the end and rotator tip. In summary, visualization of posterior medial compartment is important for the ramp region. So gill cast maneuver, intercontinental large view, and posterior medial portal is necessary. So ramp region can be repaired using all-inside technique, using suture hole. It might be technically demanding, but it's valuable to learn for patient. Thank you.

LAMP region

meniscus tail injuries

anterior visualization

ASIA function loss

trans-notch approach