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

Articles in Press

Document Type : CURRENT CONCEPTS REVIEW

Authors

1 Shahid Beheshti University of Medical Sciences

2 2. Pediatric Orthopaedic Department, Hôpital Robert-Debré, Groupe Hospitalier Universitaire AP-HP Nord-Université Paris-Cité, Paris, France

3 Tehran university of medical sciences

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

5 Department of Orthopaedics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

6 Twin Cities Orthopedics

7 5. Twin Cities Orthopedics, Edina, Minnesota, USA

8 professor of orthopaedic surgery, Department of Orthopaedics and Traumatology. University Ghent, Ghent, Belgium.

9 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran

10 Orthopedic surgery department Shariati Hospital Tehran University of Medical Sciences

10.22038/abjs.2025.88267.3998

Abstract

Medial meniscus ramp lesions are increasingly recognized as a critical yet often overlooked component of knee instability, particularly in the setting of anterior cruciate ligament (ACL) injuries. Advances in imaging techniques and arthroscopic approaches have significantly improved the detection and classification of these lesions, leading to a better understanding of their anatomical, functional, and clinical implications. Incipient evidence suggests that untreated ramp lesions may contribute to persistent knee instability and altered biomechanics, warranting a more structured and individualized treatment approach. While various arthroscopic repair techniques have been introduced, selecting the optimal method remains a challenge. The posteromedial portal technique has gained increasing attention due to its superior visualization and effectiveness in both diagnosis and repair. This narrative review provides an updated overview of ramp lesion pathophysiology, classification, diagnostic advancements, and the evolving treatment strategies, emphasizing the need for precise identification and appropriate management to enhance patient outcomes.

Keywords

Main Subjects

The Archives of Bone and Joint Surgery

Articles in Press, Accepted Manuscript
Available Online from 27 September 2025

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History

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

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