Full Title:

ACL injury with meniscus ramp lesion in 24-year-old professional athlete


Mark E. Cinque, MD, MS, Christopher M. LaPrade, MD, Gilbert Moatshe, MD, PhD, Robert F. LaPrade, MD, PhD


A 24-year-old male professional soccer player sustained an acute twisting injury during match play. He presented 1 week later and reported having acute right knee swelling and the inability to bear weight on his right lower extremity.

Physical examination demonstrated range of motion (ROM) from 0° to 100° with pain at the terminus of flexion over the posteromedial (PM) knee. Lachman and anterior drawer tests demonstrated grades of 2B and grade II, respectively. The knee was stable on posterior drawer testing and at varus/valgus stress at 0° and 30°. Furthermore, the dial test was negative at 0° and 90° and heel heights were noted to be symmetric.

Key points

  • A high level of suspicion and a comprehensive review of the imaging is vital to detect these lesions. Surgeons must scrutinize MRIs for meniscocapsular bone bruise patterns and meniscocapsular separation.
  • Failing to address a meniscal ramp lesion can result in changed knee biomechanics and increased failure rates.
  • Extra attention should be placed on ramp lesion identification in the setting of failed ACL reconstructions. Restoring of the PH MM normalizes joint contact forces and helps prevent excessive ATT, as well as external and internal rotation.
  • Excellent clinical results following ramp lesion repairs with and those without ACL reconstruction have been reported.

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ACL injury with meniscus ramp lesion in 24-year-old professional athlete