Editorial Commentary: Medial Meniscal Ramp Lesions in the Setting of Anterior Cruciate Ligament Tears Contribute to High-Grade Anterior and Rotatory Laxity That Are Normalized by Repair.

Abstract

Meniscal ramp lesions are reported to occur in 9% to 42% of anterior cruciate ligament tears. Biomechanical research shows that the presence of a meniscal ramp lesion, in the setting of an anterior cruciate ligament tear, leads to increased knee anteroposterior and rotatory laxity when compared with an uninjured medial meniscus. This finding also has been verified clinically. Repair of ramp lesions has been shown to improve biomechanics. Accordingly, the influence of meniscal ramp lesions on knee laxity necessitates a comprehensive physical examination, imaging review, and diagnostic arthroscopy to support identification and treatment of these injuries. Arthroscopic probing is required to assess ramp lesion stability. It is generally accepted that up to 30% of ramp lesions are unstable and warrant repair, as determined by tear ≤1 cm, displacement into the medial compartment with probing, and extension beyond the lower pole of the femoral condyle.