Meniscal Ramp Lesions Are More Commonly Detected on Magnetic Resonance Imaging Than Arthroscopy in Patients With Anterior Cruciate Ligament Tears

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Abstract
Purpose: To assess the prevalence of, and factors associated with, meniscal ramp lesions in patients with anterior cruciate ligament (ACL) tears. Methods: All patients who underwent primary ACL reconstruction (ACLR) during 2018 were evaluated. Preoperative magnetic resonance imaging (MRI) scans and surgical reports were reviewed searching for the presence of meniscal ramp lesions. The Greif classification was applied to MRI‐detected lesions. Univariable and multivariable logistic regression analyses, and a backward logistic regression analysis, were used to evaluate the associations between patient characteristics and concomitant knee injuries and the presence of meniscal ramp lesions on MRI and at ACLR, respectively. Results: Of the 579 patients included in this study (51.0% men; mean age 28.4 ± 11.4), 250 (43.2%) meniscal ramp lesions were diagnosed on MRI, and 57 (9.8%) were diagnosed at ACLR. None of the 25 MRI‐detected Greif´s type 1 and 2 meniscal ramp lesions were confirmed intraoperatively. Posteromedial tibial bone bruising increased likelihood of having meniscal ramp lesions on MRI (odds radio 4.04, 95% confidence intervals 2.85‐5.76; P < .001) and at ACLR (odds radio 2.29, 95% confidence intervals 1.29‐4.19; P < .01). Conclusions: Meniscal ramp lesions were frequently detected on MRI in patients undergoing ACL reconstruction, although less commonly observed at the time of surgery. MRI‐detected stable meniscal ramp lesions according to the Greif classification (type 1 and 2) showed poor surgical correlation, with no lesions identified at subsequent arthroscopy. Posteromedial tibial bone bruising on MRI was associated with the presence of meniscal ramp lesions both on MRI and at surgery. Level of Evidence: Level III, retrospective cohort study.

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