Ramp Lesion in Children: Risk Factors and Outcomes

The primary objective was to evaluate the incidence and risk factors for Meniscal Ramp Lesion (MRL), and secondarily, the rate of clinical failure, defined as the need for revision surgery for MRL at a minimum follow-up of 2 years.

A retrospective analysis of prospectively collected data was conducted on patients operated in our department, a tertiary referral center for pediatric knee surgery. All patients under the age of 18 who underwent primary or revision anterior cruciate ligament reconstruction (ACLR) between January 1, 2015, and December 31, 2018, were considered. Patients with congenital absence of the anterior cruciate ligament (ACL) or with <2 years of follow-up were excluded. This study involved 2 overlapping patient cohorts. The first, the overall ACLR cohort, included all pediatric patients who underwent ACLR with or without associated MRL. The second, the MRL cohort, included patients diagnosed intraoperatively with an MRL during ACLR within the same study period. In the overall ACLR cohort, the primary analysis evaluated the incidence of MRL and compared patients with and without MRL to identify potential risk factors. In the MRL cohort, a secondary analysis assessed the rate of subsequent surgery involving the posterior segment of the medial meniscus.

In the overall ACLR cohort (n=216), the incidence of MRL was 25.9% (56 ramp lesions identified among 216 procedures). Initial knee trauma sustained during contact sports was identified as a risk factor for the development of MRL. A total of 56 patients were diagnosed with an MRL intraoperatively, of whom 3 were lost to follow-up, leaving 53 patients in the MRL cohort. As a result, 53 patients were included in the secondary analysis. Mean follow-up time was 55.5±20.4 months (range: 24.0 to 107.0 mo). Twelve patients (22.6%) were reoperated on the posterior segment of the medial meniscus, of which 5 patients (9.4%) had partial medial meniscectomy.

MRL have a significant prevalence during ACLR in children and adolescent patients, and participation in pivot contact sport appears to be a significant risk factor of developing MRL in this specific population. The overall secondary surgery rate on the medial meniscus after MRL repair was 22.6% in this cohort.

Level IV-retrospective case series.