Meniscal Ramp Lesions: A Narrative Review of Anatomy, Diagnosis, Treatment, and Outcomes

Umile Giuseppe Longo; Beniamino Macaluso; Alessandra Corradini; Alice Ceccaroli; Alessandro de Sire; Pieter D’Hooghe

Abstract

Meniscal ramp lesions are a distinct and clinically significant pathology, frequently associated with anterior cruciate ligament (ACL) injury, particularly with high-energy rotational trauma. Epidemiological findings indicate that ramp lesions occur in 9% to 41% of ACL-injured patients, with enhanced detection when meticulous posteromedial arthroscopic evaluation is performed. While common and clinically relevant, these lesions are underdiagnosed because conventional magnetic resonance imaging (MRI) is not highly sensitive, particularly in standard sagittal and coronal planes. Consequently, arthroscopic evaluation, specifically through systematic posteromedial compartment examination, remains the gold standard for proper identification. Biomechanically, knee joint stability is compromised by ramp lesions, tibiofemoral laxity is elevated, and anterior tibial translation is increased, significantly raising the risk of progressive chondral damage and graft ACL failure. Lesion morphology, chronicity, and associated intra-articular pathology dictate treatment, with small stable tears sometimes receiving conservative treatment and larger or unstable lesions undergoing surgery. Evolution of all-inside and inside-out meniscal repair, particularly with bioabsorbable devices for fixation, has offered superior biomechanical stability and improved healing rates, with resultant decreases in postoperative instability and secondary meniscal failure. Emerging evidence points to the potential for biologic augmentation techniques, such as vascular endothelial growth factor (VEGF) injection, platelet-rich plasma (PRP), and cell-based therapies, in the enhancement of meniscal healing, particularly in avascular regions. This narrative review integrates current evidence from ramp lesion pathophysiology, epidemiology, diagnosis, treatment strategies, and long-term follow-up outcomes, pointing toward the necessity of early detection, standardized management protocols, and further research in regenerative treatments for maximizing joint preservation and functional restoration.

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