Medial meniscus ramp tears: State of the art

Medial meniscus ramp tears are tears of the posteromedial capsule or peripheral rim of the posteromedial meniscus that frequently occur with anterior cruciate ligament (ACL) tears. The incidence and prevalence of medial meniscus ramp tears has been increasing in the recent literature due to the increased understanding of the anatomy and diagnosis of these tears. When a patient presents with an ACL tear, a medial meniscus ramp tear should be suspected if the patient has a grade 3+ Lachman or pivot-shift exam, a vertical line of increased signal intensity in the posterior capsule or peripheral meniscus on magnetic resonance imaging (MRI), or posteromedial tibial plateau bone bruising on MRI. When a ramp tear is suspected, proper arthroscopic probing, including utilizing the transnotch view (or potentially an accessory posteromedial portal) or performing a medial collateral ligament trephination should be considered as part of the diagnostic workup. Once a tear is identified, a surgical repair depends on the location and stability of the tear and the surgeon's preference. The most frequently utilized techniques include the all-inside device, an all-inside suture hook, and an inside-out repair. Studies reporting on clinical outcomes for patients with ramp tears generally report no difference in outcomes compared to isolated ACL reconstruction patients. No consensus has been made on the best repair technique; however, it is generally accepted that repair is superior to leaving a ramp tear in situ as ramp tears have the potential to progress into bucket-handle tears. Further studies should work to establish a surgically and anatomically relevant classification system that clearly defines tear locations and stability to better study patient outcomes for those with a medial meniscus ramp tear. The purpose of this article is to review the anatomy, diagnosis, and treatment of medial meniscus ramp tears.