Increased attention has been directed toward the identification and treatment of concomitant knee injuries associated with anterior cruciate ligament (ACL) tears to best restore knee biomechanics and function. Studies have reported that 43% of patients with ACL tears have concomitant lateral or medial meniscal tears. Meniscocapsular tears of the posterior horn of the medial meniscus are of specific interest because of the reported difficult visualization of the posteromedial ‘‘blind spot’’ when operating via traditional anteromedial and anterolateral portals. These meniscocapsular lesions have recently been termed ramp lesions, and their incidence has been reported to be 9% to 17% of all ACL tears.
Ramp lesions are a tear of the peripheral attachment of the posterior horn of the medial meniscus at the meniscocapsular junction. Investigation of these lesions is important because recent biomechanical data suggest these lesions can result in increased anterior tibial displacement and increased strain on both the native ACL and ACL-reconstructed graft.
Much of the literature regarding ramp lesions has focused on repair techniques and outcomes after surgery. However, a relative paucity of studies is available on the diagnosis of ramp lesions using preoperative magnetic resonance imaging (MRI) with arthroscopic correlation. Given this gap in knowledge, the aim of this study was to report the incidence of ramp lesions in patients with ACL reconstruction, to determine the sensitivity of preoperative MRI for the detection of ramp lesions with comparison to the gold standard of arthroscopy, and to examine possible secondary signs of a ramp lesion on MRI.