Risk Factors for Ramp Lesions of the Medial Meniscus: A Systematic Review and Meta-analysis

Abstract

Background: Failure to appropriately identify and repair medial meniscal ramp lesions at the time of anterior cruciate ligament (ACL) reconstruction (ACLR) may result in increased anterior tibial translation and internal rotation, increasing the risk for graft failure. Knowledge of the risk factors leading to the development of ramp lesions may enhance clinicians’ vigilance in specific ACL-deficient populations and subsequently repair of these lesions at the time of ACLR. Purpose: To perform a systematic review and meta-analysis of factors tested for associations with ramp lesions and to determine which were significantly associated with the presence of ramp lesions. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, OVID/Medline, and Cochrane databases were queried in April 2020. Data pertaining to study characteristics and reported risk factors for ramp lesions were recorded. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and ramp lesions by generating effect estimates in the form of odds ratios (ORs) with 95% CIs. Qualitative analysis was performed to describe risk factors that were variably reported. Results: The review included 12 studies with 8410 patients. The overall pooled prevalence of ramp lesions was 21.9% (range, 9.0%-41.7%). A total of 45 risk factors were identified, of which 8 were explored quantitatively. There was strong evidence to support that posteromedial tibial edema on magnetic resonance imaging (MRI) (OR, 2.12; 95% CI, 1.27-3.56; P = .004), age <30 years (OR, 2.02; 95% CI, 1.23-3.22; P = .002), and complete ACL tears (OR, 3.0; 95% CI, 1.41-6.20; P = .004) were risk factors for ramp lesions. There was moderate evidence to support that male sex (OR, 1.58; 95% CI, 1.36-1.83; P < .001) and concomitant lateral meniscal tears (OR, 1.54; 95% CI, 1.11-2.13; P = .009) were risk factors for ramp lesions. Chronic ACL injury (≥24 months) demonstrated minimal evidence as a risk factor (OR, 1.41; 95% CI, 1.14-1.74; P = .001). No significant associations were determined between contact injury or revision ACLR and the presence of ramp lesions. Conclusion: Significant associations between male sex, age <30 years, posteromedial tibial edema on MRI, concomitant lateral meniscal tears, complete ACL tears, injury chronicity, and the presence of ramp lesions were found. Contact injury and revision ACLR were not significantly associated with the presence of ramp lesions.

Epidemiology of Combined Injuries of the Secondary Stabilizers in ACL-Deficient Knees: Medial Meniscal Ramp Lesion, Lateral Meniscus Root Tear, and ALL Tear: A Prospective Case Series of 602 Patients With ACL Tears From the SANTI Study Group

“…12,45 Our study also confirmed the prevalence of MMRL (24%) found by Sonnery-Cottet et al 43 in a case series of >3200 patients who had an ACL tear. In a meta-analysis, Kunze et al 25 described a significant correlation between the presence of ramp lesions and the male sex (odds ratio [OR], 1.58; P < .001), age <30 years (OR, 2.02; P = .002), and concurrent lateral meniscal tears (OR, 1.54; P = .009).…”

Short-Term Outcomes After Treatment of Isolated Hidden Meniscal Ramp Lesions

“… 3 , 5 However, many studies report risk factors for the formation of a medial meniscal ramp lesion accompanying ACL rupture. 20 , 22 , 28 In a study that included 3214 arthroscopically treated ACL rupture patients, Sonnery-Cottet et al 28 reported the prevalence of medial meniscal ramp lesion as 23.9%, while male sex, age below 30 years, chronic ACL rupture, and accompanying lateral meniscal injuries were found as risk factors for ramp lesions. In their systematic meta-analysis involving 8410 patients who underwent arthroscopic surgery for ACL rupture, Kunze et al 22 reported that male sex, total ACL rupture, and the presence of posteromedial tibial edema on preoperative MRI scans were the risk factors for an accompanying ramp lesion.…”

Meniscal ramp lesions: an illustrated review

“…In a recently published systematic review and metaanalyses by Kunze et al [10], significant associations between male sex, age < 30 years, posteromedial tibial edema on magnetic resonance imaging (MRI), concomitant lateral meniscal tears, complete ACL tears, injury chronicity, and the presence of ramp lesions were found. On the other hand, contact injury and revision of ACL reconstruction were not significantly associated with the presence of ramp lesions.…”

“…Meniscal ramp lesions are related to increased anterior translation, rotational laxity, and excessive knee motion, leading to increased biomechanical instability of the knee [4] when compared to subjects with isolated ACL tear. Failure to appropriately identify and repair medial meniscal ramp lesions at the time of anterior cruciate ligament reconstruction may result in increased anterior tibial translation and internal rotation, increasing the risk for graft failure [10].…”