Ramp lesions affect 15.3% of patients undergoing ACL reconstruction: understanding who is at risk is key to improving diagnosis.
Ramp lesions are a specific type of injury affecting the posterior horn of the medial meniscus, often associated with anterior cruciate ligament (ACL) ruptures. These lesions are frequently missed during standard arthroscopic evaluations but can significantly impact knee stability and surgical outcomes.
A recent multicentre study titled “Risk factors and prevalence of ramp lesions in ACL ruptures: An analysis from the registry of the Francophone Arthroscopic Society” offers valuable insights into the prevalence of these lesions and the key factors that contribute to their occurrence. This blog summarises the main findings of the study, which is available in full via subscription access.
Ramp lesions occur at the posterior attachment of the medial meniscus and are strongly linked to ACL injuries. Because of their location, they can be easily missed during arthroscopic surgery unless specifically looked for. Their clinical significance lies in their role in residual knee laxity: if left untreated, they may compromise the stability of the reconstructed ACL.
In this recent registry-based study, ramp lesions were identified in 822 out of 5,359 patients undergoing ACL reconstruction, resulting in a prevalence of 15.3%. This high prevalence highlights the need for systematic assessment of the posterior medial meniscus during ACL reconstruction procedures.
The researchers used both univariate and multivariate regression analyses to identify the most influential risk factors. Several patient-specific and surgical factors stood out:
Men and younger individuals were more likely to present with ramp lesions. This may be due to the higher frequency of high-energy sports and greater biomechanical stress in these groups.
Patients undergoing a revision ACL reconstruction were significantly more prone to ramp lesions. This supports the hypothesis that persistent knee instability over time increases the risk of secondary meniscal damage.
Lateral meniscal injury and low remnant volume
The presence of a lateral meniscal tear and a low volume of ACL remnant tissue were both associated with a higher risk of ramp lesions. These findings suggest a possible mechanical and biological interplay between ligament injury, meniscal integrity and healing capacity.
A positive pivot shift (indicating high-grade instability) was also associated with ramp lesions in univariate analysis. Interestingly, medial collateral ligament (MCL) injuries were associated with a lower risk of ramp lesions. The authors hypothesise that MCL injuries may alter the load distribution on the medial meniscus, offering a form of protection.
Notably, body mass index (BMI) and time from injury to surgery were not significantly associated with the presence of ramp lesions in the subgroup analysis.
The findings from this study are highly relevant for orthopaedic surgeons. By identifying patients with a high risk of ramp lesions, particularly young male patients undergoing revision surgery or those with concurrent lateral meniscal injuries, clinicians can adopt a more systematic approach to diagnosis and treatment.
For more details on surgical recommendations and data interpretation, we strongly encourage you to read the full study: “Risk factors and prevalence of ramp lesions in ACL ruptures: An analysis from the registry of the Francophone Arthroscopic Society.”
If you are considering ACL reconstruction or would like an opinion, Professor Cavaignac offers personalised consultations for patients in France and internationally.
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