Effect of Ramp Lesions on Outcomes After Anterior Cruciate Ligament Reconstruction

Ramp lesions (RLs) associated with anterior cruciate ligament (ACL) injury increase knee instability. However, whether RLs should be treated surgically remains unclear.

This study aimed to investigate the presence of RLs and compare the knee stability between patients who underwent surgical repair for unstable RLs and those who received nonoperative management for stable RLs. It was hypothesized that there would be a correlation between RLs and knee instability and that RL repair would improve postoperative knee stability.

Cohort study; Level of evidence, 3.

Overall, 180 patients who underwent primary ACL reconstruction using hamstring tendon graft were included in this study. The decision to perform surgical intervention for RLs was based on the size and instability of the RL. Knee stability was evaluated using the KT-1000 arthrometer for side-to-side difference at the manual maximum, as well as the Lachman and pivot-shift tests. Linear and logistic regression analyses were employed to examine factors associated with knee instability.

Arthroscopy confirmed RLs in 59 patients (32.8%), with a higher prevalence among women; of this total, 33 patients (55.9%) were treated nonoperatively and 26 (44.1%) underwent repair. Although the preoperative side-to-side difference in laxity in the patients with RL was significantly greater than that in patients without RL (P = .01), no significant clinical differences were observed for the preoperative Lachman test (P = .50) and pivot-shift test (P = .36). No secondary meniscal injuries occurred during the follow-up period. There were no significant differences in postoperative laxity between patients with and without RLs.

Although the presence of RLs was associated with preoperative knee instability, contrary to the hypothesis, RLs were not associated with postoperative knee instability. Stable RLs are clinically benign lesions that may tend to heal spontaneously after appropriate anatomic ACL reconstruction. Therefore, RLs may not require aggressive treatment if they are small and stable.