Medial Meniscal Ramp Tears in Patients With Anterior Cruciate Ligament Tears Undergoing Reconstruction: A Surgically Relevant Classification System Based on Tear Morphology

Purpose: To develop an anatomically and surgically relevant classification system for medial meniscal ramp tears from prospectively collected data from a consecutive series of patients undergoing anterior cruciate ligament reconstruction (ACLR) with ramp tears. Methods: A series of consecutive patients undergoing ACLR with medial meniscal ramp tears treated by 2 orthopaedic surgeons between June 2021 and May 2024 were included in this study. After arthroscopic confirmation of a medial meniscal ramp tear, the tear morphology and repair technique were noted using a ramp tear diagram, operative notes, and surgical photographs and/or videos. Tears were classified as partial or complete, stable or unstable, and superior or inferior, as well as based on whether they were in the capsule or within 3 mm of the meniscal rim. Results: A total of 115 patients with a mean age of 27.0 years (range, 13-52 years) were included and grouped into 5 distinct groups based on ramp tear morphology. Tear patterns were classified into partial stable tears (type 1; n = 8, 7.0%), partial unstable femoral-sided (meniscocapsular and superior meniscus) tears (type 2; n = 8, 7.0%), partial unstable tibial-sided (meniscotibial and inferior meniscus) tears (type 3; n = 31, 27.0%), complete separation tears (type 4; n = 46, 40.0%), and complex tears (type 5; n = 22, 19.1%). Conclusions: This study shows that it was possible to establish a medial meniscal ramp tear classification system for patients undergoing ACLR based on anatomic and arthroscopic morphologic tear documentation. In this study, tears were grouped into 5 distinct groups: partial stable ramp tears (type 1), partial unstable superior ramp tears (type 2), partial unstable inferior ramp tears (type 3), complete separation ramp tears (type 4), and complex ramp tears (type 5). Clinical Relevance: Previous studies have highlighted the importance of the ramp attachment for stability and the prevention of anterior cruciate ligament graft failure. Our classification system is based on a prospectively collected patient population and incorporates assessment of the tear for stability to probing, identification of the location of the tear, and a surgically relevant tear progression. With the described classification system, we hope to optimize repair techniques and improve outcomes associated with different ramp tear types.