Ramp lesions tend to occur near the posterior horn, where they can easily be missed during an arthroscopy.
The meniscus may be torn away from its junction with the posterior capsule.
Ramp lesions and the ACL
A significant number of anterior cruciate ligament injuries (ACL) have ramp lesions associated with them, and it is important that the surgeon actively probe the meniscocapsular rim to exclude this injury. Ramp lesions can be sutured, but the procedure needs an expert surgeon.
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Forum discussions
- Medial Meniscus - Can it rip in two?
Several patients struggling to understand tears at the back of the meniscus - eg ramp lesion, belt lesion - and why they are so challenging to the surgeon.
Peer-reviewed papers
Quote:
"....this type of injury is often missed, both during MRI reading and due to its "blind" point of arthroscopic vision....[and]....may lead to meniscocapsular or meniscotibial disruption."
Citation: Taneja AK, Miranda FC, Rosemberg LA, Santos DCB. Meniscal ramp lesions: an illustrated review. Insights Imaging. 2021 Sep 25;12(1):134. doi: 10.1186/s13244-021-01080-9. PMID: 34564751; PMCID: PMC8464645.
Quote:
"Ramp lesions play a major role in ... instability following anterior cruciate ligament rupture. The meniscotibial ligament....is the most important structure to repair and is the primary stabilizer of the posterior horn of the medial meniscus....Different techniques have been described to repair [tears of the posterior horn of medial meniscus], particularly ramp lesions....[but]....the failure rate remains high".
Citation: Guy S, Ferreira A, Carrozzo A, Delaloye JR, Cavaignac E, Vieira TD, Sonnery-Cottet B. Isolated Meniscotibial Ligament Rupture: The Medial Meniscus "Belt Lesion". Arthrosc Tech. 2022 Jan 13;11(2):e133-e138. doi: 10.1016/j.eats.2021.09.013. PMID: 35155104; PMCID: PMC8821026.