Incidence and Treatment Strategy of Lateral Meniscus Posterior Root Tears and Ramp Lesions Identified During Isolated ACL Reconstructions: Report From a Nationwide Knee Ligament Register

Håvard Visnes; Andreas Persson; Anne Marie Fenstad; Eivind Inderhaug

doi:10.1177/23259671251399817

Incidence and Treatment Strategy of Lateral Meniscus Posterior Root Tears and Ramp Lesions Identified During Isolated ACL Reconstructions: Report From a Nationwide Knee Ligament Register

Orthop J Sports Med. 2025 Dec 23;13(12):23259671251399817. doi: 10.1177/23259671251399817. eCollection 2025 Dec.

Authors

Håvard Visnes^{1

2

3}, Andreas Persson^{1

2

4}, Anne Marie Fenstad¹, Eivind Inderhaug^{1

5

6}

Affiliations

¹ The Norwegian Knee Ligament Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.
² Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway.
³ Department of Orthopedics, Sorlandet Hospital Kristiansand, Kristiansand, Norway.
⁴ Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
⁵ Sports Traumatology and Arthroscopy Research Group, University of Bergen, Bergen, Norway.
⁶ Haukeland University Hospital, Bergen, Norway.

Abstract

Background: Meniscus repair is increasingly common during primary anterior cruciate ligament reconstruction (ACLR), particularly because of an increased focus on the severity of untreated lateral meniscus posterior root tears (LMPRTs) and ramp lesions. However, the incidence and current treatment strategies for these injuries across a larger population remain unclear as previous reports come from selective cohort studies.

Purpose: To report on the incidence of LMPRTs and ramp lesions in primary ACLR in Norway, compare patient- and activity-related characteristics in those with and without these injuries, and describe current treatment strategies.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: Data from the Norwegian Knee Ligament Register (2018-2023) were analyzed. The study included patients undergoing isolated ACLR. Sex, age, weight, preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) scores, sports participation, and meniscus treatment strategy were considered.

Results: Of 5309 ACLR knees, 68% (n = 3605) had 1 or more recorded meniscus injuries, while LMPRTs and ramp lesions were seen in 10% and 7.8%, respectively. The ramp lesion tears were more frequently seen in younger patients (P < .001) and resulted in lower preoperative KOOS scores than in the LMPRT group, which comprised older patients exhibiting reduced preoperative KOOS scores. Winter sports exhibited the highest sport-specific incidence of LMPRTs (14.3%) and ramp lesions (14.2%). LMPRT treatment predominantly involved transtibial suturing with cortical fixation, while ramp lesion management was split between all-inside and other suturing techniques (including repairs through a posteromedial portal).

Conclusion: This first nationwide registry study identified a high incidence of concomitant meniscus tears in ACLR, with incidences of LMPRTs and ramp lesions of 10.0% and 7.8%, respectively. Patients with ramp lesions were significantly younger than both those with LMPRTs and those without meniscus injuries. Treatment for LMPRTs predominantly involved transtibial sutures with cortical fixation, while treatment for ramp lesions was divided between all-inside suturing techniques and other suturing methods (including repairs through a posteromedial portal).

Keywords: ACL reconstruction; epidemiology; lateral meniscus posterior root tear; meniscus; ramp lesion.