The natural long-term course of unrepaired ramp lesion: a retrospective analysis of 28 patients followed for at least 20 years

OBJECTIVES: Ramp lesion is a specific type of injury, located in the posterior horn of the medial meniscus. The purpose of the study was to evaluate the complications for meniscal ramp lesions left in situ during ACL reconstruction, after more than 20 months of follow up. METHODS: All patients who underwent arthroscopic ACLR between January 1998 and December 2000 were evaluated retrospectively. Surgery was performed by the same surgeon. In case of a stable vertical tear, i.e. without instability, the lesion was left in situ, without suture or debridement. The following parameters were examined: demographics; history and clinical findings including time between injury and surgery, side-to-side laxity, pivot shift; knee function and activity by Lysholm score, subjective IKDC, KOOS and Tegner activity scale; and progression to bucket handle. We established two groups: the bucket handle group versus the no bucket handle group. RESULTS: A total of 716 patients underwent a primary ACLR during this period. The overall incidence of ramp lesions in the study population was 5.4% (39 ramp lesions in 716 patients). Mean follow-up time was 262.1 (± 10.5) months. Bucket handle tear of the medial meniscus occurs in 21.4% of our population, with an average lead time of 99 (± 50) months, and a concentration of injuries between 96 and 156 months. The postoperative scores significantly improved for the entire population at more than 20 years of follow-up (p <0.0001), except for the Tegner score (p = 0.3424). Functional scores and side-to-side laxity were the same for the two groups. No risk factors were identified. CONCLUSION: There is a high incidence of bucket-handle injury after ACL surgery with a residual ramp lesion (21.4%). This high rate is only found in series with a long follow-up, since these lesions appear between 8 and 12 years after the first surgery.