Prevalence of Meniscal Ramp Lesions According to the Type of Anterior Cruciate Ligament Tear: A Magnetic Resonance Imaging Study

PURPOSE: Meniscal ramp lesions are frequently associated with anterior cruciate ligament (ACL) injuries but may be overlooked during arthroscopy, potentially affecting surgical planning and outcomes. This study aimed to evaluate the prevalence and types of meniscal ramp lesions on magnetic resonance (MR) imaging and to assess the relationship with ACL tear patterns and clinical variables. METHODS: This retrospective study included 122 patients who underwent knee MR imaging before arthroscopic ACL reconstruction. ACL tears were classified as both-bundle or selective bundle tears based on arthroscopic findings. Meniscal ramp lesions were classified into 5 subtypes on MR imaging. Associations among meniscal ramp lesion prevalence, lesion subtype, ACL tear pattern, and clinical variables, including body mass index, were analyzed. RESULTS: Meniscal ramp lesions were detected in 74.6% and 77.0% of patients by reader 1 and reader 2, respectively. Meniscal ramp lesions were significantly more frequent in both-bundle ACL tears than in selective bundle tears (84.0% vs. 56.1% for reader 1; 84.0% vs. 63.4% for reader 2; P<0.05). There was no significant difference in ramp lesion prevalence between anteromedial and posterolateral bundle tears or in ramp lesion subtype distribution according to ACL tear pattern. CONCLUSIONS: Meniscal ramp lesions are highly prevalent in patients with ACL tears and occur more frequently in both-bundle tears. MR imaging plays a critical role in detecting ramp lesions and may improve preoperative assessment and surgical planning.