ramp lesion: From epidemiology to surgical treatment

Meniscal ramp lesions are more frequently associated to ACL injury. It can be defined as a lesion to the menisco-capsular junction of the posterior horn of the medial meniscus. The incidence of isolated ramp lesion is unknown, but the prevalence of ramp lesion in association with acl injury is reported ranging from 9% to 17%. Objective evaluation may not be of high suspicion for ramp lesion. Magnetic resonance imaging scans have been reported to have low sensitivity. the gold standard for ramp lesion diagnosis is still the arthroscopic evaluation. a postero-medial compartment evaluation through a trans-notch view is mandatory. postero-medial accessory portal should be performed only when necessary. treatment of ramp lesion is still controversial. Stable lesions may be treated with debridement only, while unstable lesions need to be repaired. Inside-out and all-inside technique are the most commonly used because of the potential risk of saphenous neurovascular bundle damage with the outside-in technique. good outcomes of ramp lesion repair are reported using both the surgical techniques, but there are few studies with short follow-up, so it is still not possible to conclude about the best surgical technique. the purpose of this study is to review the available literature about meniscal ramp lesion and to summarize the epidemiology, diagnostic strategies and recommended treatment options.