Ramp Lesions: An Unrecognized Posteromedial Instability?

Abstract

Objective: Meniscal ramp lesions are a “hot topic” because of increasing recognition that they have important biomechanical consequences and also that they occur much more frequently than was previously understood. Historically, ramp lesions have been underdiagnosed because of the low sensitivity of MRI and inadequate visualization through standard arthroscopic anterior viewing portals. A systematic exploration of the posteromedial compartment of the knee via a trans-notch approach is needed to confirm or refute the presence of a meniscal ramp lesion. If left untreated, meniscal ramp lesions may contribute to residual anteroposterior instability in the anterior cruciate ligament–reconstructed knee and may also result in failure of meniscal repair. Recent epidemiologic data and definition of risk factors helps to inform an appropriate index of suspicion, identification, and adequate treatment of ramp lesions.