Editorial Commentary: Medial Meniscal Ramp Tears Require Comprehensive Evaluation and Treatment

Various classifications have been proposed for medial meniscal ramp tears, but none have been subjected to validation, reliability, or outcome analysis. A medial meniscal ramp tear is a peripheral detachment of the posterior horn of the meniscus due to either a tear of the meniscocapsular junction or the meniscotibial ligament, or both. Ramp tears are commonly found in association with anterior cruciate ligament rupture. The fascial expansion of the semimembranosus tendon is attached to the posterior horn of the medial meniscus; excessive anterior translation of the tibia stimulates the semimembranosus to contract, resulting in a ramp tear. Risk factors include deep and superficial medial collateral ligament injuries, steep medial tibial slope, flatter lateral tibial slope, varus alignment greater than 3°, posteromedial tibial bone contusion on magnetic resonance imaging (MRI), Segond fracture, and a chronic injury (3 months or more from injury). Untreated ramp lesions are associated with increased anterior knee laxity, which may increase the risk of anterior cruciate ligament graft failure. Diagnosis of a ramp tear is not always straightforward. MRI has only moderate sensitivity because the posterior capsule tightens in extension, reducing meniscocapsular separation. High-resolution MRI with the knee in flexion can improve accuracy. Nevertheless, the gold standard for diagnosis is arthroscopy. Unstable tears should be repaired, and as the meniscocapsular junction has good vascularity, some stable tears may heal after abrasion or trephination. A good classification system should characterize a problem, determine the best treatment, and predict the outcome. Classification systems also aid the consistent reporting and comparison of clinical data.