Epidemiology: Prevalence, Incidence, and Implications of Ramp Lesions

Abstract

Meniscal ramp lesions are defined as longitudinal peripheral tears in the medial meniscus where the meniscocapsular and meniscotibial ligaments connect to the posterior horn. Meniscal ramp lesions are commonly associated with ACL tears but can easily be overlooked due to low sensitivity of diagnosis via MRI and their location posterior to the posterior horn of the medial meniscus. Left untreated, ramp lesions can lead to pain, decreased knee function, altered knee kinematics, and a decreased quality of life. Due to the impact meniscal ramp lesions can have on a patients' overall function, it is recommended to have a high index of suspicion for meniscal ramp lesions. Also, it is imperative to establish and utilize a posteromedial portal to directly probe the posterior horn of the medial meniscus when investigating the presence and stability of meniscal ramp lesions. Treatment options for meniscal ramp lesions can be non-operative, biological treatment, or meniscal repair with suture fixation. Non-operative management can be considered for stable lesions, while different operative techniques including inside-out, and all-inside repair have been described for meniscal ramp lesions requiring surgical fixation. Overall, Meniscus ramp lesions show good healing potential, as an excellent healing rate of 89% after meniscus ramp lesion repair has been reported and biological treatment such as trephination or rasping has also been shown to have positive results, whether done in isolation for more stable lesions or done in conjunction with suture fixation.