[Objective] To compare the clinical efficacy of arthroscopic suture hook and Fast-fix repair for type IV Ramp injury. [Methods] Retrospective analysis of clinical data of 45 patients with anterior cruciate ligament (ACL) injuries combined with type IV Ramp area injury of the meniscus from January 2016 to October 2020. Among them, 21 cases were treated with suture hook and 24 cases were treated with Fast-fix. Comparative analysis of perioperative period, follow-up, and imaging results. [Results] All patients underwent successful surgeries without complications such as vascular or nerve injuries. The surgical duration and total incision length in suture hook Group was longer than that in Fast-fix Group [(5.9±0.5)cm vs (5.1±0.6)cm, P<0.001；(91.2±10.6)min vs (62.5±8.4)min, P<0.001]. The hospitalization costs in suture hook Group was less than that in Fast-fix Group[(3.4±0.3)cm vs (4.3±0.7) ten thousand yuan, P<0.001]. There were no statistically significant differences in Ramp tear length, number of sutures and length of hospital stay between the two groups (P>0.05). All patients were followed up for 36 to 72 months. The postoperative pivot shift test, Lachman test, range of motion of knee, tenderness, McMurray sign, IKDC score, and Lysholm score were all improved compared to preoperative values in both groups (P<0.001). However, there were no significant differences in the above indexes between the two groups at the same time (P>0.05). According to the Barrett healing criteria for meniscal repair, at 1 year postoperatively, complete healing rates of of suture hook Group and Fast-fix Group Ramp injuries was 90.48% and 95.83%, respectively, and the difference was not statistically significant (P>0.05). MRI at 1 year postoperatively showed complete healing of Ramp injuries of suture hook Group and Fast-fix Group was 90.48% and 87.5%, respectively, and the difference was not statistically significant (P>0.05). [Conclusion] Arthroscopic suturing hook and Fast-fix suturing for type IV Ramp injury of the meniscus can achieve satisfactory clinical outcomes.