Clinical efficacy of ramp lesion treatment: a systematic review and meta analysis study

Ramp lesions, tears involving the peripheral attachment of the posterior horn of the medial meniscus, significantly impact knee stability and function, particularly in association with anterior cruciate ligament injuries. However, evidence regarding optimal treatment strategies remains inconclusive. This systematic review and meta-analysis aimed to evaluate and compare the clinical efficacy of various treatment modalities for ramp lesions. A comprehensive systematic search was conducted across major electronic databases, including PubMed, Scopus, and Web of Science, up to June 2025. Studies were included based on predefined eligibility criteria. Data extraction was performed and meta-analytic synthesis was conducted using random-effects models. A total of 17 studies met inclusion criteria. The pooled mean difference demonstrated significant improvements in both IKDC (MD=28.5 points; 95% CI: 27.9-29.2) and Lysholm scores (MD=28.5 points; 95% CI: 27.9-29.2). Subgroup analyses revealed notable effectiveness for AIR compared to CM and PM, with statistically significant subgroup differences (p<0.05). The overall treatment success rate was 87% (95% CI: 83-92%). Across techniques, patient-reported outcomes improved markedly (IKDC fixed-effect pooled Mean Difference [MD] 28.8 points, 95% CI 28.2-29.4; random-effects overall effect significant; I²=98%). In anterior vs posterior all-inside subgroups, IKDC showed no robust between-approach difference on the random-effects test (χ²=0.51, p=.48), with a small fixed-effect difference (χ²=4.34, p=.04). Lysholm scores also improved substantially (fixed-effect pooled MD 28.0 points, 95% CI 27.3-28.7), and the between-approach difference was significant, favoring the posterior subgroup on the fixed-effect model. The pooled clinical success proportion was 90% without a significant difference between approaches (p=.10). The findings indicate that surgical interventions, particularly All-inside repair has effectively improved knee function and patient-reported outcomes following ramp lesions compared to conservative management and partial meniscectomy. However, no significant difference was detected between anterior and posterior all-inside repair techniques.