Arthroscopy - 2026-08-16 - Journal Article
Meniscal Ramp Lesions Are More Commonly Detected on Magnetic Resonance Imaging Than Arthroscopy in Patients With Anterior Cruciate Ligament Tears.
Lerjefors E, Cristiani R, von Essen C, Johansson F, Stålman A
Topics
Key Takeaway
MRI detected ramp lesions in 43.2% of ACL-injured knees, but only 9.8% were confirmed arthroscopically, with Greif type 1 and 2 lesions showing 0% surgical correlation.
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Summary
This study assessed ramp lesion prevalence and associated factors in 579 patients undergoing primary ACLR in 2018, comparing MRI detection rates to intraoperative findings using the Greif classification. MRI identified ramp lesions in 43.2% of patients versus 9.8% at arthroscopy; Greif type 1 and 2 lesions had zero intraoperative confirmation. Posteromedial tibial bone bruising was the strongest predictor of ramp lesions on both MRI (OR 4.04) and at surgery (OR 2.29).
Key Limitation
Absence of a standardized arthroscopic probing protocol means the 9.8% surgical detection rate likely underestimates true ramp lesion prevalence, making the MRI-to-arthroscopy discordance partially artifactual.
Original Abstract
PURPOSE
To assess the prevalence of, and factors associated with, meniscal ramp lesions in patients with anterior cruciate ligament (ACL) tears.
METHODS
All patients who underwent primary ACL reconstruction (ACLR) during 2018 were evaluated. Preoperative magnetic resonance imaging (MRI) scans and surgical reports were reviewed searching for the presence of meniscal ramp lesions. The Greif classification was applied to MRI-detected lesions. Univariable and multivariable logistic regression analyses, and a backward logistic regression analysis, were used to evaluate the associations between patient characteristics and concomitant knee injuries and the presence of meniscal ramp lesions on MRI and at ACLR, respectively.
RESULTS
Of the 579 patients included in this study (51.0% men; mean age 28.4 ± 11.4), 250 (43.2%) meniscal ramp lesions were diagnosed on MRI, and 57 (9.8%) were diagnosed at ACLR. None of the 25 MRI-detected Greif´s type 1 and 2 meniscal ramp lesions were confirmed intraoperatively. Posteromedial tibial bone bruising increased likelihood of having meniscal ramp lesions on MRI (odds radio 4.04, 95% confidence intervals 2.85-5.76; P < .001) and at ACLR (odds radio 2.29, 95% confidence intervals 1.29-4.19; P < .01).
CONCLUSIONS
Meniscal ramp lesions were frequently detected on MRI in patients undergoing ACL reconstruction, although less commonly observed at the time of surgery. MRI-detected stable meniscal ramp lesions according to the Greif classification (type 1 and 2) showed poor surgical correlation, with no lesions identified at subsequent arthroscopy. Posteromedial tibial bone bruising on MRI was associated with the presence of meniscal ramp lesions both on MRI and at surgery.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.