ramp lesion (meniscus)

Meniscal ramp
lesions: an illustrated review. Type 1 meniscal ramp lesion MRI Case. Sagittal (a) and axial T2-weighted fat-suppressed images show meniscocapsular tear (arrow) with tibial bone bruise, and the extension of meniscocapsular junction edema (arrowheads)
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Meniscal ramp
lesions: an illustrated review. Type 4A meniscal ramp lesion illustration, defined as complete peripheral posterior horn meniscal tear
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Meniscal ramp
lesions: an illustrated review. Sagittal T2-weighted fat-suppressed MR image (a) shows a zip lesion, with a rip between Wrisberg ligament (curved arrow) and posterior horn of lateral meniscus. Axial T2-weighetd fat-suppressed MR image (b) shows the lesion in a cross-sectional view (arrowheads)
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Meniscal ramp
lesions: an illustrated review. (a) Sagittal fat-suppressed MR image shows a type 4 acute ramp lesion (arrow) and in (b) the postoperative appearance after 4 months of surgery (arrow)
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Meniscal ramp
lesions: an illustrated review. Type 5 meniscal ramp lesion MRI case. Sagittal PD-weighted fat-suppressed MR image (a, left) shows a postoperative ACL graft tear (arrow), and sagittal T2-weighted fat-suppressed (b, right) shows a double vertical peripheral tear through the posterior horn of medial meniscus (thin arrows). *Case courtesy of Dr. Diego Lemos (USA)
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Meniscal ramp
lesions: an illustrated review. Type 5 meniscal ramp lesion illustration, defined as peripheral posterior horn meniscal double tear
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Meniscal ramp
lesions: an illustrated review. Type 4B meniscal ramp lesion MRI case. Sagittal (a) T2-weighted fat-suppressed MR image shows a type IV ramp lesion, with a complete meniscocapsular disruption of the posterior horn of medial meniscus. Axial (b) image shows a cross-sectional view of the extensive meniscocapsular disruption
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Meniscal ramp
lesions: an illustrated review. Type 4B meniscal ramp lesion illustration, defined as complete meniscocapsular junction tear
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Meniscal ramp
lesions: an illustrated review. Type 4A meniscal ramp lesion MRI Case. Sagittal (a) and axial (b) T2-weighted fat-suppressed MR image shows a type IV ramp lesion, with tear extending from femoral to tibial articular surfaces (arrow); tear extension is seen in (b) (arrowheads)
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Meniscal ramp
lesions: an illustrated review. Type 1 ramp lesion illustration, defined as meniscocapsular ligament tear
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Meniscal ramp
lesions: an illustrated review. Posterior medial meniscus anatomy, with its corresponding structures. In (a), an illustrated open view of the medial compartment of the knee, in (b), a zoomed view of the posteromedial capsular-meniscal unit, and in (c), the corresponding MRI appearance on sagittal PD-weighted fat suppressed: meniscocapsular ligament (thin arrow), meniscotibial ligament (curved arrow) and posterior capsular attachment (star)
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Meniscal ramp
lesions: an illustrated review. Type 3B meniscal ramp lesion illustration, defined as a partial inferior tear affecting the meniscotibial ligament
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Meniscal ramp
lesions: an illustrated review. Type 3A meniscal ramp lesion MRI Case. Sagittal T2-weighted fat-suppressed images show peripheral vertical partial tear (arrow in a) extending to the tibial surface of the posterior horn of medial meniscus, with intact meniscotibial ligament (arrowhead in b)
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Meniscal ramp
lesions: an illustrated review. Type 3A meniscal ramp lesion illustration, defined as partial inferior peripheral posterior horn meniscal tear
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Meniscal ramp
lesions: an illustrated review. Type 2 meniscal ramp lesion MRI Case. Sequential sagittal T2-weighted fat-suppressed MR images show peripheral partial tear of posterior horn of medial meniscus (arrows) affecting the femoral articular surface, along with meniscocapsular ligament tear
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Meniscal ramp
lesions: an illustrated review. Type 2 meniscal ramp lesion illustration, defined as partial superior peripheral posterior meniscal horn tear
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Meniscal ramp
lesions: an illustrated review. Type 3B meniscal ramp lesion MRI Case. Sagittal (a) and axial (b) T2-weighetd fat-suppressed images show peripheral partial vertical tear affecting the tibial surface of the posterior horn of medial meniscus (arrow), along with meniscotibial ligament tear (curved arrow) and bone bruise; extension of vertical tear is seen in (b) (arrowheads)
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Radiopaedia • CC-by-nc-sa 3.0 • de

Ramp lesions are defined as a vertical (longitudinal) tear of the peripheral capsular attachment of the posterior horn medial meniscus at the meniscocapsular junction . As it is a minor injury and has a hidden location using standard anterolateral and anteromedial arthroscopic portals, its identification guides the orthopedic surgeon to identify it on arthroscopy by probing of the posterior horn of the medial meniscus, which may require an additional portal .

Epidemiology

In ACL-deficient knees, the incidence is reported at ~12.5% (range 9-17%) .

Pathology

Ramp lesions most frequently occur in the setting of a pivot shift mechanism of injury (e.g. anterior cruciate ligament (ACL) injuries) . It is suggested to be due to disruption of the meniscotibial ligaments, or as a result of a tear of the peripheral attachment of the posterior horn of the medial meniscus .

Associations

The presence of ramp lesions is associated with :

  • ACL rupture
  • ACL graft failure
  • increased risk of developing osteoarthritis

Radiographic features

MRI

Ramp lesions appear as an abnormal signal at the peripheral most portion of the posterior horn of the medial meniscus. They can be difficult to identify if there is little or no posterior meniscocapsular tissue separation.

The most specific signs are complete thin linear fluid signal between the posterior horn of the medial meniscus and posteromedial capsule and posterior meniscal irregularity . Posteromedial tibial plateau marrow edema may be present as an additional indicator of a ramp lesion .

Treatment and prognosis

If unstable, ramp lesions can be repaired arthroscopically .

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Assoziationen und Differentialdiagnosen zu Rampenläsion Meniskus:
meniskokapsuläre
Verbindung
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menisko-kapsuläre
Separation
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