Abstract
PurposeThe aim of the current study was (1) to provide an overview of common definitions and classification systems of ramp lesions (RL) and (2) to systematically review the available literature with regard to the diagnosis and treatment of RLs in anterior cruciate ligament (ACL)-deficient knees.MethodsFollowing the PRISMA guidelines, MEDLINE and Scopus were searched for articles (1) reporting on acute or chronic ACL injuries, (2) with concomitant medial meniscus injury, (3) located at the posterior meniscocapsular attachment site (and red–red zone). Ex vivo studies, reviews and technical notes were excluded.ResultsTwenty-seven studies were included based on the criteria mentioned above. RLs are common in ACL-deficient knees with a prevalence ranging from 9 to 24%. RLs should especially be suspected in younger patients, patients with an increased meniscal slope and in patients with prolonged time from injury to surgery. The sensitivity of MRI for the detection of RLs ranges from 48 to 86% at a specificity of 79–99%. For arthroscopy, RLs are easily missed through standard anterior portals (sensitivity 0–38%). RL repair leads to a significant improvement of subjective knee scores, regardless of the specific fixation technique. For stable RLs, the literature suggests equivalent postoperative stability for trephination and abrasion compared to surgical RL repair.ConclusionRamp lesions are frequently missed in ACL-deficient knees on standard arthroscopy with anterior portals only. If a RL is suspected, exploration via an additional posteromedial portal is indicated. In case of instability, RL repair should be performed.Level of evidenceIV.
Highlights
The mechanisms of anterior cruciate ligament (ACL) rupture and concomitant knee injuries have been extensively investigated over the last decades, revealing that the minority of ACL ruptures occurs as an isolated injury [12, 20]
The reviewed literature reports a prevalence of ramp lesions (RL) in ACLdeficient knees ranging from 9 to 24% [3, 35]
This study demonstrates that anterolateral ligament repair (ALLR) can have a protective effect on RL repair; yet, the effect of RL repair itself was not analysed
Summary
The mechanisms of anterior cruciate ligament (ACL) rupture and concomitant knee injuries have been extensively investigated over the last decades, revealing that the minority of ACL ruptures occurs as an isolated injury [12, 20]. Meniscal tears have been reported to be present in 55% up to nearly 80% of ACL injuries, with significantly higher rates in chronically ACL-deficient knees [12, 26, 46]. Time to surgery correlates with the incidence of concomitant meniscus injuries [25, 29]. The incidence of medial meniscus (MM) tears seems to significantly. Patients with medial or lateral meniscus instabilities have a significantly increased risk of ACL failure after reconstruction [32]. Early ACL reconstruction (ACLR) and meniscal repair are recommended to prevent secondary meniscus injuries and improve the long-term outcome [12, 27]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
