Beyond the ACL: The Hidden Impact of Ramp Tears on Knee Stability

Medial meniscus ramp lesions have emerged as a critical but frequently overlooked contributor to knee instability, particularly in the context of anterior cruciate ligament (ACL) injuries. Recent advances in imaging and arthroscopic techniques have improved their detection and classification, enhancing our understanding of their anatomical and functional significance. Evidence indicates that untreated ramp lesions may perpetuate instability and alter knee biomechanics, underscoring the need for structured, individualized treatment. Although multiple arthroscopic repair strategies have been proposed, the optimal technique remains debated. The posterior portals approach offers superior visualization and reliable repair, and has gained increasing adoption. This review synthesizes current insights into ramp lesion pathophysiology, classification, diagnostic advances, and evolving management strategies, emphasizing the importance of accurate identification and tailored intervention to optimize patient outcomes.