PURPOSE: The purpose of this study was to develop an anatomically and surgically relevant classification system for medial meniscus ramp tears from prospectively collected data from a consecutive series of patients undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) with ramp tears. METHODS: A series of consecutive patients from two orthopedic surgeons between June 2021 to May 2024 undergoing ACLR with medial meniscus ramp tears were included in this study. After arthroscopic confirmation of a medial meniscus ramp tear, the tear morphology and repair technique were noted using a ramp tear diagram, operative notes, and surgical photos/videos. Tears were classified as partial or complete, stable or unstable, superior or inferior, and if they were in the capsule or within 3 mm of the meniscus rim. RESULTS: A total of 115 patients with a mean age of 27.0 years (range, 13 - 52 years) were included and grouped into five distinct groups based on ramp tear morphology. Tear patterns were classified into partial stable tears (Type 1, N=8, 7.0%), partial unstable femoral-sided (meniscocapsular and superior meniscus) tears (Type 2, N=8, 7.0%), partial unstable tibial-sided (meniscotibial and inferior meniscus) tears (Type 3, N=31, 27.0%), complete separation tears (Type 4, N=46, 40.0%), and complex tears (Type 5, N=22, 19.1%). CONCLUSIONS: This study demonstrates that it was possible to establish a medial meniscus ramp tear classification system for patients undergoing ACLR based on anatomic and arthroscopic morphological tear documentation. In the current study, tears were grouped into five distinct groups: partial stable ramp tears (Type 1), partial unstable superior ramp tears (Type 2), partial unstable inferior ramp tears (Type 3), complete separation ramp tears (Type 4), and complex ramp tears (Type 5). CLINICAL RELEVANCE: Previous studies have highlighted the importance of the ramp attachment for stability and preventing ACL graft failure. This classification system is based on a prospectively collected patient population and incorporates assessment of the tear for stability to probing, identification of the location of the tear, and a surgically relevant tear progression. With this new classification system, we hope to optimize repair techniques and improve outcomes associated with different ramp tear types.