Surgical Delay Increases the Incidence of Ramp Lesions and Bucket-Handle Tears in Anterior Cruciate Ligament Injuries

To investigate the correlation between surgical delay and the incidence of ramp lesions by performing meticulous arthroscopic evaluation of the posterior compartment in patients undergoing anterior cruciate ligament (ACL) reconstruction.

This retrospective cohort study included patients who underwent primary ACL reconstruction between July 2015 and January 2023. To minimize underdiagnosis of ramp lesions, all patients received comprehensive arthroscopic evaluation of the posterior compartment via intercondylar notch view and posteromedial or posterolateral portals. Meniscal tears were classified on the basis of Cooper's system, and radial and longitudinal tear components were analyzed separately. Patients were categorized into 3 groups according to time from injury to surgery: group 1 (<6 weeks), group 2 (6 weeks-6 months), and group 3 (>6 months). Incidence and tear patterns were compared among groups.

A total of 201 patients were included in the study. The overall incidence of meniscal tears was lowest in group 2 (50%) compared with group 1 (73%; P = .02) and increased again in group 3 (75%; P = .04 vs group 2). Ramp lesions were significantly more common in group 3 than in group 2 (52.8% vs 23.1%; P = .02). Medial bucket-handle tears also increased significantly in group 3 (22.2%) compared to group 1 (2.9%) and group 2 (0%) (P < .01 and P = .02, respectively).

A surgical delay of more than 6 months was associated with a higher incidence of medial ramp lesions, which can progress to bucket-handle tears in ACL-deficient knees. Early surgical intervention should be considered in ACL ruptures accompanied by rotational instability to prevent progression of medial meniscal pathology.

Level III, retrospective cohort study.