Meniscal ramp lesions: an illustrated review

Abstract

The purpose of this review is to describe the anatomy and lesions affecting the peripheral portion of posterior horn of medial menisci (ramp lesions), along with illustrations and MRI cases. We will correlate imaging features with arthroscopic classification of ramp lesions. Also, postoperative and chronic changes related to meniscocapsular tears will be presented, as well as biomechanical consequences and treatment approach.

Characterization and Prevalence of Pediatric Ramp Lesions Associated with Anterior Cruciate Ligament Tears.

“…[15] ramp lesions occur at the attachments of the meniscocapsular ligament and meniscotibial ligament at the middle level of the posterior horn meniscus length. [1] anatomically, the posterior capsule does not attach directly to the superior portion of the PHMM, providing evidence for the potential location of hidden meniscal ramp lesions when the knee is near full extension. [4] this hidden area may be responsible for missed diagnoses of ramp tears during preoperative Mri scans, and it further supports the utility of checking this area with a probe and/or viewing the PHMM posteromedially during arthroscopy to confirm or disprove the presence of a ramp lesion at the time of acL surgery.…”

“…Other reports analyzing the accuracy of Mri for these lesions have ranged from 48-85%, and subsequent arthroscopy for confirmation of diagnosis and treatment is necessary. [1,9,11,12,14,17,19,20,23] Arner et al…”

“…may lead to meniscocapsular or meniscotibial disruption, often associated with acL ruptures. [1] a meniscocapsular separation at the PHMM is of special interest because of its potential hidden location within the posterior septum, especially when the knee is near full extension.…”

Lateral Meniscus Zip Lesion of Knee: Classification and Repair Methods

“…The tear must extend more than 1.4 cm in the mediolateral direction from the lateral edge of posterior cruciate ligament. 5 Zip lesion is equivalent to the medial-sided ramp lesion. Although various techniques, classification, and biomechanical studies have been described for the ramp, similar literature is lacking for the zip lesions.…”

Anchor-Based Meniscal Ramp Repair

“…Ramp lesions are most common during traumatic, acute knee ligament injuries or in chronic ACL-deficient knees. 2 Ramp lesions are estimated to be present in upwards of 24% of patients undergoing ACL reconstruction. 1 , 3 , 4 In acute injuries, men and patients younger than 30 are more likely to have simultaneous ACL and ramp lesions.…”