MOJ
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Commentary Volume 15 Issue 1
Meniscal ramp lesions
Cunha Raquel, Queiros Carlos Mesquita
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Centro Hospitalar Entre Douro e Vouga, Portugal
Correspondence: Carlos Queirós, MD, Centro Hospitalar Entre Douro e Vouga, Alameda Jardins D’Arrabida, 438, 9oB 4400-438,Vila Nova de Gaia, Portugal
Received: February 01, 2023 | Published: February 15, 2023
Citation: Raquel C, Mesquita QC. Meniscal ramp lesions. MOJ Orthop Rheumatol. 2023;15(1):23. DOI: 10.15406/mojor.2023.15.00612
Commentary
Meniscal ramp tears are lesions of the posterior third of the medial meniscus with rupture of the tibialmeniscus ligaments that usually occur after violent contraction of the ischiotibials in response to anterior subluxation of the tibia following ACL rupture. They may be present in up to 20% of ruptures, most commonly in patients with increased tibial slope and in chronic ruptures.1 They are called "Hiden Lesions" as they are not visualized by classical inspection with conventional ports, so for their diagnosis a systematic arthroscopic evaluation of the posteromedial recess of the knee is necessary.2
At MRI we may find posteromedial bony edema of the tibial plate, or a peripheral rupture of the medial meniscus, or just edema of the posteromedial structures. However, due to the extended position of the knee during the examination, the posterior recess is eliminated, making diagnosis difficult.3 This lesion is crucial to the biomechanics of the knee, both in terms of anterior and rotational stability. In knees with ACL rupture, the concomitant lesion of the meniscal ramp increases not only anterior translation but also external and internal rotation with consequent greater degrees of the "pivot-shift" phenomenon. Thus, isolated ACL reconstruction in the presence of an untreated ramp lesion only restores anterior translation, failing to restore normal knee rotations.4
Their classification is anatomically descriptive into 4 types and has no influence on treatment or prognostic value.5 The suture of these lesions may be carried out with all-inside suture devices, catching the tibial meniscus ligaments in one of the passages, or with suture hooks through the posteromedial portal. Although the latter adds greater technical difficulty, it has a lower failure rate.6
Even if the presence of the ramp lesion does not significantly alter the outcome and functional scores of the ACL reconstruction, this lesion should be diagnosed and treated, as rates of subsequent meniscal lesion have been described in up to 1/3 of patients.7
Acknowledgments
None.
Conflicts of interest
The authors declare that there are no conflicts of interest.
References
- Abreu FG, Canuto SMG, Canuto MMG, et al. Incidence of meniscal ramp lesion in anterior cruciate ligament reconstructions. Rev Bras Ortop (Sao Paulo). 2022;57(3):422–428.
- Bertrand Sonnery-Cottet , Jacopo Conteduca, Mathieu Thaunat, et al. Hidden lesions of the posterior horn of the medial meniscus: a systematic arthroscopic exploration of the concealed portion of the knee. Am J Sports Med. 2014;42(4):921–926.
- Kim Y, Ahn JM, Kang Y, et al. Uncovered Medial Meniscus Sign on Knee MRI: Evidence of Lost Brake Stop Mechanism of the Posterior Horn Medial Meniscus. AJR Am J Roentgenol. 2018;211(6):1313–1318.
- DePhillipo NN, Moatshe G, Brady A, et al. Effect of Meniscocapsular and Meniscotibial Lesions in ACL-Deficient and ACL-Reconstructed Knees: A Biomechanical Study. Am J Sports Med. 2018;46(10):2422–2431.
- Thaunat M, Fayard JM, Guimaraes TM, et al. Classification and Surgical Repair of Ramp Lesions of the Medial Meniscus. Arthrosc Tech. 2016;5(4):e871–e875.
- Gousopoulos L, Hopper GP, Saithna A, et al. Suture Hook Versus All-Inside Repair for Longitudinal Tears of the Posterior Horn of the Medial Meniscus Concomitant to Anterior Cruciate Ligament Reconstruction: A Matched-Pair Analysis From the SANTI Study Group. Am J Sports Med. 2022;50(9):2357–2366.
- Tuphé P, Foissey C, Unal P, et al. Long-term Natural History of Unrepaired Stable Ramp Lesions: A Retrospective Analysis of 28 Patients With a Minimum Follow-up of 20 Years. Am J Sports Med. 2022;50(12):3273–3279.
©2023 Raquel, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.