Summary

to determine the prevalence and characteristics of the ramp lesion

Abstract

Introduction

Longitudinal tear of the medial meniscus posterior horn around the meniscocapsular junction is commonly associated with ACL rupture and is termed a “ramp lesion”. These lesions may be difficult to visualize using traditional arthroscopic portals. However, its identification requires careful arthroscopic posteromedial viewing, and there are only few reports about epidemiologic characteristics of the ramp lesion. The purpose of this study was to determine the prevalence and characteristics of the ramp lesion.

Methods

We prospectively examined the presence of ramp lesion in consecutive 58 knees (45 males, 13 females) underwent ACL reconstruction from January 2015 to June 2016. Even if the ramp lesion is present, the medial meniscus is not displaceable and is stable to probing, and the medial meniscus posterior horn seems normal in standard anterior viewing. Therefore, we passed the 30° arthroscope from anterolateral portal through the intercondylar notch between the posterior cruciate ligament and the medial femoral condyle into the posterior recess and detected the ramp lesion. All ACL reconstruction surgeries were done using the anteromedial medial and anterolateral lateral portals using quadrupled semitendinosis graft. Additionally an intercondylar notch view was performed to visualize the posteromedial menisco-capsular junction to identify the ramp lesions. In those case where ramp lesions were identified an additional posteromedial portal was made to repair these lesions. These menisco-capsular tears were repaired using all inside technique using PDS.
The effects of age, gender, and time from injury on the prevalence of ramp lesions were analyzed.

Results

RAMP lesion of the meniscus was seen in 9 knees (15.51%) and other meniscal tears in medial meniscus were seen in 31 knees (53.44%) during ACL reconstruction. The mean ages at the time of surgery in former and latter group were 32.7 and 35.1 years, a significant difference (P < .05). The time from injury was 60.4 days (mean) in knees with ramp lesion while it was 607 days(mean) in the other group which was statistically significant. The gender was not significantly different between groups

Conclusion

This study showed that the ramp lesion which is often missed if not looked for was more likely to be associated with younger patients. The ramp lesion could be identified if the patients presented earlier for surgery. Because we can’t always expect the presence of ramp lesion in preoperative MRI, posteromedial viewing through the intercondylar notch during surgery should be routinely performed so as not to overlook it. The repair involves an additional Posteromedial portal and the rehabilitation was that of a standard ACLR with meniscal repair. The surgeon has to be on guard and should be looking for the ramp lesions in all ACL tear knees since its incidence is quite high.