Reviews: Review Article

Meniscal Ramp Lesions: Anatomy, Epidemiology, Diagnosis, and Treatment

Brophy, Robert H. MD; Steinmetz, R. Garrett MD; Smith, Matthew V. MD; Matava, Matthew J. MD

From the Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.

Smith or an immediate family member is a Speaker for Elite Orthopedics, Arthrex; serves as a consultant for Flexion Therapeutic. Matava or an immediate family member serves as a consultant for Arthrex Inc., Elite Orthopedics, Pacira Pharmaceuticals, Heron Therapeutics, Schwartz Biomedical, Breg Inc. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Brophy and Steinmetz

Journal of the American Academy of Orthopaedic Surgeons 30(6):p 255-262, March 15, 2022. | DOI: 10.5435/JAAOS-D-21-00091

CME Test

Abstract

Injuries to the medial meniscus meniscocapsular junction, also known as ramp lesions, are common in the setting of anterior cruciate ligament injuries with a prevalence of 9% to 42%. Anatomically, ramp lesions involve disruption of the posterior meniscocapsular junction and meniscotibial ligaments. Biomechanically, ramp lesions are associated with an increase in anterior tibial translation and internal and external tibial rotation in anterior cruciate ligament–deficient cadaveric knees. Magnetic resonance imaging is useful in evaluating the meniscocapsular junction. Irregularity or increased signal near the posterior meniscocapsular junction and/or signal change indicative of posterior medial tibial plateau edema can suggest these injuries are present before surgical intervention. The current benchmark for diagnosis is arthroscopic visualization of the posterior medial meniscocapsular junction viewed through the intercondylar notch. Once a ramp lesion is identified, stability should be assessed by arthroscopic probing to determine the degree of anterior displacement. Optimal treatment has been debated in the literature, especially for stable ramp lesions, although good outcomes have been shown with and without repair. Repair is warranted for those lesions that are unstable to probing. Unfortunately, only limited literature available to guide clinicians on the optimal rehabilitation for ramp lesions.