Novel type of medial meniscus ramp lesion: a case report and surgical technique

Meniscal ramp lesions have been reported in 9-24% of patients who underwent anterior cruciate ligament reconstruction (ACLR). We report a rare type of double medial meniscus ramp lesion in in a 26-year-old male soccer player who presented with persistent knee instability and an inability to return to sports after a successful ACLR due to unaddressed and untreated ramp lesions. To the best of our knowledge, this is the first reported case of a double ramp lesion, with tears occurring in two separate locations: one tear at the meniscosynovial junction and associated with meniscotibial ligament disruption; and a second, more posteriorly located at the meniscocapsular junction and associated with meniscocapsular attachment disruption. It was found to be very unstable upon arthroscopic assessment and was clinically associated with persistent knee instability even after ACLR, thus necessitating surgical repair to restore knee kinematics.