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

Magnetic Resonance Imaging Evaluation of Meniscal Ramp Lesions and their Association with Anterior Cruciate Ligament Injury Severity: A Retrospective Observational Study.

The strong association with ACL injury and having a potentially important role in knee stabilisation, their injuries need to be given due importance by radiologists and should not be underreported.

Diagnostic Performance of MRI for Posterolateral Meniscocapsular Detachment in ACL-Injured Knees: A Retrospective Study

Background/Objectives: Posterolateral meniscocapsular detachment represents a potentially underrecognized component of knee trauma in patients with anterior cruciate ligament (ACL) injury. Altered rotational kinematics in ACL-deficient knees may increase stress on posterolateral corner structures. Although an association between ACL tears and posterolateral abnormalities has been reported, the true diagnostic performance of magnetic resonance imaging (MRI) for these lesions remains incompletely defined. This study aimed to evaluate the diagnostic accuracy of MRI for posterolateral meniscocapsular detachment in patients with confirmed ACL injury, to describe associated meniscal tears, and to assess the association between lateral tibial plateau bone marrow edema, age, and sex with the presence of detachment. Methods: In this retrospective study, 117 knee MRI examinations (1.5 T and 3 T) of patients with native ACL rupture or ACL graft failure were reviewed. Two readers independently assessed posterolateral meniscocapsular detachment. Ramp lesions, other meniscal tears and lateral compartment bone marrow edema were evaluated in consensus. Arthroscopy served as the reference standard. Diagnostic performance and inter-observer agreement were calculated. Detachment was considered present only when both readers independently identified the lesion. Results: MRI demonstrated high specificity (90.8%; 95% CI: 83.7–95.5%) for posterolateral meniscocapsular detachment, and promising sensitivity (87.5%; 95% CI: 47.3–99.7%) based on a small number of confirmed cases (n = 8); this estimate should be interpreted with caution given the wide confidence interval. One arthroscopically confirmed lesion was missed, and false-positive findings were limited. MRI also showed good diagnostic performance for ramp lesions and other associated meniscal tears, assessed as secondary endpoints. Lateral tibial plateau bone marrow edema, age, and sex were not significantly associated with detachment. Conclusions: Routine MRI shows high specificity and promising, although preliminary, sensitivity for detecting posterolateral meniscocapsular detachment in ACL-injured knees; given the small number of confirmed cases, this estimate warrants confirmation in larger cohorts. Careful multiplanar assessment and detailed anatomical knowledge are essential to optimize detection. Accurate preoperative MRI characterization may help guide surgical planning and reduce the risk of missed posterolateral meniscocapsular pathology at arthroscopy.

Prevalence and risk factors of medial meniscal ramp lesions in patients undergoing primary anterior cruciate ligament reconstruction at a tertiary center.

BACKGROUND Ramp lesions are injuries of the peripheral meniscocapsular attachment of the posterior horn of the medial meniscus and are commonly associated with anterior cruciate ligament (ACL) tears. Failure to identify these lesions may compromise knee stability and outcomes after ACL reconstruction (ACLR). PURPOSE The primary objective of this study was to determine the prevalence of ramp lesions among patients undergoing primary ACLR at a tertiary center in Saudi Arabia. The secondary objective was to identify patient- and injury-related risk factors associated with ramp lesions. STUDY DESIGN Retrospective cross-sectional study. METHODS This retrospective cross-sectional study included adult patients who underwent primary ACL reconstruction between November 2022 and December 2025. Patients with prior surgery, multiligamentous injuries (except MCL injuries), fractures, or incomplete records were excluded. Ramp lesions were identified intraoperatively. Demographic and clinical variables were analyzed using univariate logistic regression. RESULTS Among 155 patients, ramp lesion prevalence was 3.9% (6/155). Older age and longer time from injury to surgery were significant predictors (p < 0.05). On continuous analysis, both age (OR = 1.151, 95% CI 1.024-1.294; p = 0.018) and time from injury to surgery (OR = 1.028, 95% CI 1.005-1.052; p = 0.017) remained significant. Sex, BMI, MCL injury, and lateral meniscal injury were not significantly associated. CONCLUSION Our findings suggest that older age and longer time from injury to surgery are associated with the occurrence of ramp lesions. Future prospective studies should assess the prevalence of ramp lesions while minimizing information and observer bias and should investigate the interplay among knee morphometry, activity level, and biomechanical forces leading to ramp lesion development across diverse populations. The relatively low prevalence observed in this study may be related to diagnostic limitations, as ramp lesions are often missed when only standard anterior arthroscopic portals are used. Techniques such as posteromedial exploration or trans-notch visualization may improve detection. Differences in surgical technique and surgeon awareness may also influence identification, highlighting the need for systematic intraoperative evaluation.

Quantifying the current impact of listing ACL reconstructions as low priority on subsequent meniscal pathology.

INTRODUCTION Anterior cruciate ligament (ACL) ruptures can cause knee instability, potentially leading to meniscal and chondral injury if left untreated. Recent guidance suggests listing ACL reconstruction as lower priority without meniscal pathology. This study examines the risk of subsequent meniscal tears with delayed surgery. METHODS We conducted a retrospective cohort study (January 2018-March 2024) of consecutive patients who underwent ACL reconstruction. Patients were categorised by preoperative magnetic resonance imaging (MRI) findings of meniscal tears, and time from listing to surgery. Intraoperative findings of meniscal tears were recorded. Nonparametric testing and binary logistic regression determined risk factors for meniscal pathology with delayed surgery. RESULTS Among 272 patients, 15.1% had new meniscal tears identified intraoperatively that were absent on initial MRI scan, with a male-to-female ratio of 3:1. Additionally, 5% had MRI-detected pathology not confirmed surgically. Median time to diagnosis was 21 days, and median time to surgery was 140 days. Age and time to diagnosis did not affect outcomes (p>0.05). Body mass index (BMI) differences were not significant overall but became significant when outliers (BMI>43) were excluded (p=0.038). Logistic regression, adjusting for sex and BMI, showed a 0.3% increase in meniscal tear risk per waiting day (p=0.013). CONCLUSIONS This study highlights the risk factors and progression of meniscal tears following delayed ACL reconstruction. Patient BMI and waiting list duration are important factors for risk reduction. With a delay of a month to surgery, the likelihood of developing a meniscal tear increases by nearly 10%. These findings emphasise the importance of early intervention, and potential re-evaluation of the current guidance.

Patellofemoral morphology is associated with ACL rupture in pediatric patients: a quantitative MRI-based case-control study.

Meniscal Ramp Lesions: A Narrative Review of Anatomy, Diagnosis, Treatment, and Outcomes