RAMP Lesion with ACL Tear
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Is a 33-year-old woman
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with twisting injury while playing soccer 10 days prior.
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Again, scrolling from medial to lateral.
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You see, there's some subcutaneous edema,
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but the m the MCL was, was okay.
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Here. When we get to the, um, medial meniscus, you can see
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that there's this increased signal at the periphery
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of the medial meniscus At the posterior horn,
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we don't see any discernible meniscocapsular
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or meniscal tibial ligaments.
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And there's this bone marrow edema.
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And so this is a ramp lesion.
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Um, this is meniscocapsular separation to be more precise.
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And here's the PCL.
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The ACL was completely torn,
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and as we get to the posterior horn of lateral meniscus,
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the root didn't look that bad there.
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There's some, there's partial tearing.
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Um, and this, uh, posterior horn
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of lateral meniscus is, uh, floating.
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And the meniscal, um, the duo, meniscal sic are torn.
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And this is the, uh, publius, uh, tendon.
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And you can see that the, uh, inner margin of
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that posterior horn is blunted
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consistent with the radial tear.
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So, uh, this is the arthroscopic image, um, of that, um,
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uh, posterolateral of, of, of this, basically this, uh,
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lateral, lateral femoral condyle.
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You see an empty wall, uh,
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and that's consistent with the ACL tear,
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which they reconstructed.
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And with the scope in the poster lateral portion
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of the joint, this is the populus tendon, which corresponds
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to this populus tendon that you see over here.
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And the radial tear, uh, was right in front
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of the populous tendon.
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You can see that the more medial or,
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or central portion of that posterior horn is more elevated.
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Um, there's a portion
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of the posterior inferior popal meniscal fascicle, uh,
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peeking through here.
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And this is a nice correlate of this, this area.
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And so they debrided this down to a stable margin.
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Um, it, it didn't require further stabilization.
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Uh, they didn't need any sutures.
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Uh, the ramp lesion is very important to point out
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to the surgeons if they're not looking, um, in this area,
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you can see that with the, with the standard anterior
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portal, this, uh, body
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and the posterior horn of the medial meniscus,
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it looks not too bad, but when they take the scope
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and they pass it underneath the PCL
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and into that poster medial compartment, uh,
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this is the trans condylar view.
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You can see that this, this capsule, um, as it attaches
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to the, uh, body, uh, the posterior horn
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of the medial meniscus here.
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So this is the push horn of the medial meniscus,
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and there's a large tear.
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Um, and so this is the ramp lesion.
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This is what a normal, uh, meniscal, capsular,
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or ramp area looks like. Uh, this most meniscal
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Capsular attaches very nicely to the posterior horn
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of the, uh, medial meniscus.
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And they actually made a posterior portal.
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Uh, they used an arthroscopic RAs, uh,
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rasp to clean up these areas.
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And, uh, uh, suture fixed the whole thing.
Donald Resnick, MD
Professor Emeritus, Department of Radiology
University of California, San Diego
Mini N. Pathria, MD, FRCP(C)
Division Chief, Musculoskeletal Imaging
University of California San Diego
Eric Y. Chang, MD
Adjunct Professor, Radiology
University of California, San Diego
Brady K. Huang, MD
Clinical Professor of Radiology
UC San Diego Medical Center
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