Ramp lesion in anterior cruciate ligament injury: a review of the anatomy, biomechanics, epidemiology, and diagnosis

Abstract

Ramp lesions, commonly observed in patients with anterior cruciate ligament (ACL) injuries, have been previously defined as longitudinal tears around the meniscocapsular junction. However, the definitions and interpretations of ramp lesions have varied, emphasizing the need to confirm their presence before surgery and the importance of direct visualization using arthroscopy. Recent histological studies have reported new findings on ramp lesions, shedding light on their attachment mechanisms. The anatomical structures around the ramp lesion, such as the posterior horn of medial meniscus (PHMM), semimembranosus (SM), posteromedial (PM) capsule, and meniscotibial ligament (MTL), were assessed regarding how these structures could be attached to each other. The studies of ramp lesions have also contributed to the progression of biomechanical studies explaining the cause and effects of ramp lesions. Ramp lesion has been proven to stabilize the anteroposterior (AP) instability of ACL. In addition, various laboratory studies have demonstrated the relationship between rotational instability of the knee joint and ramp lesions. The analysis of risk factors of ramp lesion helped to understand the injury mechanism of the lesion. Many authors have evaluated the prevalence of ramp lesions in patients with ACL injuries. The development of arthroscopy techniques has influenced the outcomes of ACL reconstruction with the easy detection of ramp lesions. This review article aims to analyze the past findings and recent advancements in anatomical, biomechanical, and epidemiological studies of ramp lesions in patients who underwent ACL reconstruction, and provide various perspectives ramp lesions in patients with ACL reconstruction.

Medial meniscal lesions increase antero‐posterior laxity in knees with anterior cruciate ligament injury

“…This is a key aspect, since meniscal tears represent one of the most common injuries in orthopaedics, with a mean annual incidence of 60−70 per 100.000 [23], and since patients undergoing ACL reconstruction have been reported to have a meniscus tear incidence from 55% up to nearly 80% [24][25][26][27][28]. Meniscal lesions should therefore be carefully considered when performing ACL reconstruction surgery to restore knee stability [29][30][31][32]. In fact, while meniscectomy can increase the femoro-tibial contact stress and anterior tibial translation in ACL-deficient knees, meniscal repair showed to increase anteromedial knee laxity [8,33].…”

A High-Grade Lachman’s Exam Predicts a Ramp Tear of the Medial Meniscus in Patients with Anterior Cruciate Ligament Tear: A Prospective Clinical and Radiological Evaluation

“…Medial meniscus ramp tears are meniscal tears associated with anterior cruciate ligament (ACL) tears and have been reported to be more prevalent when an ACL reconstruction (ACLR) is delayed [1]. Medial meniscus ramp tears have been described as longitudinal tears of the posterior horn of the medial meniscus at the meniscocapsular junction, affecting either the meniscocapsular (superior attachment), meniscotibial (inferior attachment), or both attachments [1,2]. A complete separation of the meniscocapsular junction occurs when both the meniscocapsular and meniscotibial attachments are torn.…”

“…Medial meniscus ramp tears have detrimental effects on overall knee stability and if left untreated, can contribute to the early progression of osteoarthritis [9]. Biomechanical studies have reported that concomitant ACL and medial meniscus ramp tears increase anterior tibial translation and internal rotation of the knee compared to an isolated ACL tear state [1,10,11]. Additionally, repairing a ramp tear can restore near native knee biomechanics compared to the unrepaired state [10,11].…”

Osteoarthritis Development Following Meniscectomy vs. Meniscal Repair for Posterior Medial Meniscus Injuries: A Systematic Review

“…Integral to knee function, the menisci mitigate the forces transmitted across the knee, reducing the risk of cartilage damage and osteoarthritis [11][12][13][14][15]. The medial meniscus, being C-shaped and firmly attached to the knee's capsule, is particularly vulnerable to injury, underscoring the importance of preserving its integrity for maintaining knee health [16][17][18][19][20].…”