Ramp lesions of the medial meniscus are associated with a higher grade of dynamic rotatory laxity in ACL-injured patients in comparison to patients with an isolated injury.

PURPOSE: The purpose of this study was to compare preoperative knee laxity between two groups of patients with primary or revision ACL reconstruction with or without an associated ramp lesion of the medial meniscus. METHODS: Two-hundred and seventy-five patients with an ACL reconstruction (243 primaries; 32 revisions) were prospectively screened using direct arthroscopic visualisation and divided into a ramp lesion group (RLG) and a control group (CG) regardless of the presence of other associated meniscal tears. All patients were clinically examined under anaesthesia before surgery by grading the Lachman and pivot shift tests. RESULTS: Fifty-eight patients were included in the RLG. The CG included 217 patients. With all meniscus lesions included, there were no significant differences between the two groups. After excluding all other meniscus lesions in both groups except for ramp lesions in the RLG, the prevalence of a grade III pivot shift was higher in the RLG (32 remaining patients; 47% grade III) compared to the CG (91 remaining patients; 24% grade III, p = 0.02). The difference of patients with a grade III pivot shift between the CG and RLG remained significant after removal of revision ACL reconstructions (CG, 85 remaining patients; 25% grade III-RLG, 27 remaining patients; 44% grade III, p = 0.05). CONCLUSION: Patients with an isolated ramp lesion of the medial meniscus in association with an ACL injury displayed a higher amount of dynamic rotational laxity as expressed by the pivot shift test in comparison to patients with isolated ACL injury and no ramp lesion. The association between ramp lesions of the medial meniscus and increased pivot shift grading suggests that it is important to diagnose and repair them during ACL reconstruction surgery. LEVEL OF EVIDENCE: III.