[ACL-associated ramp lesions of the medial meniscus].

Meniscosynovial lesions (MSL) are often associated with injuries of the anterior cruciate ligament (ACL). The detection of these injuries is often limited or even not possible using a routine anterior arthroscopy of the knee joint or by preoperative radiological diagnostics. The clinical relevance of these lesions is not yet fully clarified. Recent biomechanical studies have shown an increased anteroposterior and rotational laxity of the joint in unrepaired MSL. For these reasons, they are thought to be connected with the premature failure of ACL reconstructions. Inspection of the posteromedial knee joint compartment in arthroscopically confirmed ACL lesions via the trans-notch portal and examination of the meniscocapsular structureswith a hook probe via a posteromedial access portal should be routinely carried out. In the diagnosis of MSL the repair contributes to a significant improvement of the knee joint laxity and therefore possibly to better long-termresults with simultaneous ACL reconstruction. Reconstruction of the posteromedial structures is technically demanding and is arthroscopically carried out via one or two posteromedial access portals.