Incidence, Arthroscopic Detection, and Clinical Outcomes of Ramp Lesions in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Prospective Observational Study

Abstract

Abstract Introduction: Ramp lesions are tears involving the meniscocapsular or meniscotibial attachment of the posterior horn of the medial meniscus and are commonly associated with anterior cruciate ligament (ACL) injuries. These lesions are frequently missed on pre-operative magnetic resonance imaging (MRI) and may contribute to persistent knee instability if left untreated. The present study aimed to determine the incidence of ramp lesions in patients undergoing ACL reconstruction, evaluate the diagnostic yield of systematic arthroscopic assessment compared with MRI, and assess their association with pre-operative instability and post-operative functional outcomes. Materials and Methods: This prospective observational study included 50 patients with ACL tears who underwent arthroscopic ACL reconstruction at a tertiary care center. Demographic characteristics, mechanism of injury, MRI findings, arthroscopic findings, associated intra-articular injuries, and clinical outcome measures were recorded. Ramp lesions were identified through systematic arthroscopic evaluation of the posteromedial compartment. Functional outcomes were assessed using the Lysholm Knee Score and International Knee Documentation Committee (IKDC) score. Statistical analysis was performed using the Statistical Package for the Social Sciences version 26.0, with P < 0.05 considered statistically significant. Results: The incidence of ramp lesions was 28.0% (14/50 patients). MRI detected 8 of 14 ramp lesions (57.1%), whereas arthroscopy identified all lesions, with MRI missing 42.9% of cases. Patients with ramp lesions demonstrated significantly greater pre-operative instability, with positive pivot shift tests in 85.7% and Grade III Lachman tests in 78.6% of cases. Mean Lysholm scores improved from 49.3 ± 8.6 to 90.6 ± 5.2, whereas mean IKDC scores improved from 44.7 ± 7.8 to 85.8 ± 6.0 at 6 months postoperatively. Overall, 86.0% of patients experienced no post-operative complications. Conclusion: Ramp lesions are common associated injuries in ACL-deficient knees and are frequently underdiagnosed on MRI. Systematic arthroscopic evaluation significantly improves detection rates and facilitates appropriate management. Early identification and treatment of ramp lesions during ACL reconstruction result in excellent functional recovery and favorable clinical outcomes.