2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Ramp Lesions In Chronic ACL Injury

Asjad Mahmood, MS Orthopaedics, Fellowship in Arthroscopy (2yrs), New Delhi, Delhi INDIA
Department of Orthopaedics, AIIMS, NEW DELHI, Delhi, INDIA

FDA Status Not Applicable

Summary

Meniscal ramp lesions are frequently associated with anterior cruciate ligament (ACL) injuries. Unrecognized ramp lesions during ACL reconstruction are increasingly identified as a factor contributing to the failure of the procedure. This study was conducted to determine the incidence of ramp lesions in patients with ACL injuries and to analyze the characteristics of these patients within our popu

Abstract

Background

Meniscal ramp lesions associated with ACL injuries are being increasingly reported in the literature. This study aims to assess the incidence of ramp lesions in ACL-injured patients at a tertiary care hospital in India and to examine the characteristics of these patients.

Methods

This prospective case series included all patients undergoing ACL reconstruction from January 2021 to December 2022. Demographic parameters, including the mode of injury and the interval between injury and surgery, were documented. Diagnostic arthroscopy findings during ACL reconstruction were recorded and analyzed. In each case, the posteromedial compartment of the knee was examined through anterior portals using a trans-notch view, and the decision to create a posteromedial compartment was based on the visualization of a ramp lesion. Identified ramp lesions were repaired. A standardized surgical technique and postoperative rehabilitation protocol were followed in all cases. Preoperative MRIs were also evaluated for the presence of ramp lesions.

Results

A total of 164 patients were included in this study, with an incidence of ramp lesions of 19.51%. The time from injury to surgery was significantly longer in patients with ramp lesions. Preoperative MRI had a sensitivity of only 46.87% in detecting ramp lesions. During anterior probing, increased mobility of the posterior horn of the medial meniscus was observed in only 25 out of 32 patients.

Conclusion

To avoid missing ramp lesions, it is crucial to visualize the posterior compartment of the knee during arthroscopy in all patients undergoing ACL reconstruction. Preoperative MRI is not a reliable tool for diagnosing ramp lesions.