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

Document Type : CURRENT CONCEPTS REVIEW

Authors

1 Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Pediatric Orthopaedic Department, Hôpital Robert-Debré, Groupe Hospitalier Universitaire AP-HP Nord-Université Paris-Cité, Paris, France -Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran

3 Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran

4 Poursina Orthopedic research center, Guilan University of Medical science, Guilan, Iran

5 Shahid Beheshti University of Medical Sciences, Tehran, Iran

6 Twin Cities Orthopedics, Edina, Minnesota, USA

7 Department of Orthopedics, Ghent University Hospital, Ghent, Belgium

8 Department of Orthopaedics and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

10.22038/abjs.2025.88267.3998

Abstract

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.
        Level of evidence: IV

Keywords

Main Subjects

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The Archives of Bone and Joint Surgery
Volume 14, Issue 4
April 2026
Pages 267-284

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History

  • Receive Date: 15 May 2025
  • Revise Date: 27 August 2025
  • Accept Date: 30 August 2025

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