Arthroscopic Meniscal Ramp Tear Repair

Ramp lesions of the posterior horn of the medial meniscus have received increased attention over the last decade due to their high prevalence in patients undergoing anterior cruciate ligament reconstruction. The diagnosis of these lesions is not reliable with preoperative imaging and quite limited with routine anterior arthroscopic inspection of the knee joint. Visual inspection of the posteromedial compartment of the knee joint should thus systematically be carried out via a trans-notch view and probing of the meniscocapsular structures with a needle or direct visualization via an additional posteromedial viewing portal. While the clinical impact of ramp lesions has not yet been well established, recent biomechanical studies have shown increased anteroposterior and rotational laxities in the presence of a ramp lesion. Leaving these lesions untreated may thus impact ACL reconstruction outcomes leading to postoperative residual laxity with potential failure of the graft or a secondary lesion of the medial meniscus. To date, it remains unclear whether all ramp lesions should be repaired as only a few publications report long-term outcomes. This chapter provides an overview of the current knowledge of ramp lesions including their diagnosis, classification, biomechanical relevance as well as treatment options and outcomes.