Summary

The ramp lesion of medial meniscus is associated with ACL rupture in a blind spot when looking by anterior regular arthroscopic view.

Abstract

Purpose

The objectives of this study were to perform an epidemiological evaluation of meniscal ramp lesions in patients with anterior cruciate ligament (ACL) tears, and to determine the risk factors related to the injury in the Brazilian population.

Methods

824 patients who underwent ACL reconstruction (ACLR) were retrospectively surveyed. During arthroscopy, patients who presented medial meniscal instability underwent evaluation of the posteromedial compartment of the knee. Ramp repair was performed if a lesion was detected. Potential risk factors were analyzed for their association with ramp lesions.

Results

The overall incidence of ramp lesions in the study population was 10,6% (87 ramp lesions among 824 patients). Multivariate analysis using the Chi-Square test demonstrated that the presence ramp lesions was significantly associated with the following risk factors: right laterality and chronic injuries. Sex, age and sports activity were not statistically significant. Football was the most frequent cause of ramp lesions related to sports, with 78.2% of the cases. However, it has not been shown to be a risk factor. The incidence per year ranged from 4.0% to 20.6%.

Discussion

The incidence of meniscal ramp lesions was 10.6% in ACLR. What stands out is the increasing annual incidence in the period studied, ranging from 4.0% in 2014 to 20.6% in 2019. This shows that the number of diagnoses of meniscal ramp lesions increases as the surgeon's arthroscopic skills and experience also increase. To improve diagnostics and treatments for ramp lesions during the learning curve, we recommend the surgeons to recognize the risk factors associated with them, and also to create a routine for evaluating the posteromedial compartment during ACL procedures.