The fate of unrepaired stable ramp lesions: a systematic review

This study was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta- Analyses) guidelines. PubMed and Medline databases were searched in October 2023 for studies reporting outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction and stable medial meniscal ramp lesion treatment. Studies focused on diagnostic approaches, biomechanical properties, unstable ramp lesions, isolated ramp lesions, and concomitant intraarticular/extraarticular pathologies other than ACL rupture are excluded. A total of 314 studies were obtained after the initial search. Six studies met the inclusion criteria. Data from 186 stable medial meniscal ramp lesions that were left unrepaired were retrieved. At the last follow-up, mean preoperative Lysholm and IKDC scores were significantly improved and similar with repair patients and no ramp lesion patients, postoperatively. Healing rate was reported between 58.6% and 87.8%. Knee stability was similar in repaired and nonrepaired patients and a ramp existed and no ramp lesion patients. Although the return to sports rate was similar between ramp existed and no ramp lesion patients, the time to return to sports was higher in ramp existed patients than no ramp patients. Improved functional outcome scores, similar healing rates, knee stability, and return to sports rates can be obtained in repaired and nonrepaired patients as well as ramp lesions existing and no ramp lesion patients when the stable ramp lesions are left unrepaired. The time to return to sport is significantly higher than no ramp lesion patients. Level of Evidence III.