Journal of Pediatric Orthopaedics - 2026-09-01 - Journal Article
Ramp Lesion in Children: Risk Factors and Outcomes.
Baltzer J, Josse A, Raux S, Chotel F
Topics
Key Takeaway
Meniscal ramp lesions occur in 25.9% of pediatric ACLR patients, with contact pivot sports as a significant risk factor and a 22.6% reoperation rate on the medial meniscus at mean 55.5 months.
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Summary
This study evaluated MRL incidence, risk factors, and reoperation rates in patients under 18 undergoing ACLR at a single tertiary pediatric center from 2015–2018. MRL was identified intraoperatively in 25.9% of 216 procedures, with contact pivot sport participation identified as a significant risk factor. Among 53 MRL patients with adequate follow-up, 22.6% required reoperation on the posterior medial meniscus, including 9.4% who underwent partial medial meniscectomy.
Key Limitation
Single-center retrospective design with no standardized MRL repair technique reported limits generalizability and prevents attribution of reoperation risk to repair method versus patient or lesion characteristics.
Original Abstract
PURPOSE
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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 OF EVIDENCE
Level IV-retrospective case series.