Medial Meniscal Ramp Lesions: An Arthroscopic Classification

Medial meniscus ramp lesions are commonly associated with anterior cruciate ligament injuries. These lesions were defined previously as longitudinal tears around the meniscocapsular junction at the level of the posterior horn of the medial meniscus. However, the recent interpretation of the ramp lesions, their causation, anatomical studies, and histologic studies has uncovered a different dimension to these lesions. With recent knowledge of anatomy and soft-tissue attachments around the posterior horn of the medial meniscus, the attachments of the articular capsule, posteromedial capsule, meniscocapsular ligament, meniscotibial ligament, and semimembranosus, there is a need to understand these injuries differently. Because the anatomical structures injured during the ramp lesion will decide the treatment strategy to repair it anatomically, a review of the classification and repair techniques is necessary. The existing classification is descriptive and does not suggest a repair strategy for each classification. Because the ramp lesion, by definition, does not affect the meniscus tissue, it is a peel-off injury of the posteromedial structures. Hence, injury to the meniscus without injury to the meniscocapsular ligament, or meniscotibial ligament, cannot be classified as a ramp lesion. This article proposes an arthroscopic and functional classification.