Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 4, pp 1074–1079 | Cite as

Ramp lesions in ACL deficient knees in children and adolescent population: a high prevalence confirmed in intercondylar and posteromedial exploration

  • Matthieu Malatray
  • Sebastien Raux
  • Adrien Peltier
  • Clemence Pfirrmann
  • Romain Seil
  • Franck Chotel



Ramp lesions are common in ACL deficient knees. Their diagnosis is difficult and, therefore, they may be underestimated. So far, no study analyzed their prevalence in a pediatric population. The diagnosis of these Ramp lesions is of major clinical relevance because of a frequent misestimating and technic difficulties. Ramp lesions might be associated with residual knee pain and instability after ACL reconstruction. The aim of this study was to evaluate the prevalence of ramp lesions explored through a systematic intercondylar and posteromedial arthroscopic approach during an ACL reconstruction in a pediatric and adolescent population.


Children and adolescents who underwent an ACL reconstruction were screened prospectively between October 2014 and 2016. The presence or absence of a ramp lesion was evaluated after each of three arthroscopic steps: (1) an anterior approach, (2) an intercondylar inspection, and (3) a posteromedial approach. Ramp lesions were screened at each step and their prevalence was evaluated. Furthermore, their presence was correlated to age, weight, size, sex, and state of the physis (open or closed). Finally, the meniscal status on MRI and arthroscopic findings were compared.


Fifty-six patients were analyzed. The median age was 14.0 ± 1.3 years (12–17). The median interval between injury and surgery was 11.5 months (1–108). During step 1 (anterior approach), only 1 ramp lesion (2%) was diagnosed. 13 (23%) ramp lesions were found after inspection through the intercondylar notch. No additional lesions were found with a direct view through the posteromedial approach. No correlation between ramp lesions and side, sex, weight, size, or state of physis was found. 10 ramp lesions out of 13 could not be diagnosed on MRI.


The prevalence of ACL-associated ramp lesions in children and adolescents is similar to adult populations. A systematic inspection through the intercondylar notch is recommended during ACL reconstruction to make a precise diagnosis. The posteromedial approach is essentially useful for meniscal repair

Level of evidence

Testing, previously developed diagnostic criteria in a consecutive series of patients and a universally applied “gold” standard, Level I.


ACL reconstruction Posterior horn of the medial meniscus Ramp lesions Arthroscopic approach Prevalence Children Adolescents 


Compliance with ethical standards

Conflict of interest

SR, AP, CP, RS, and FC declare that they have no conflict of interest with this study.

Ethical approval

All procedures performed in this study involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained drom all individual participants included in the study.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2017

Authors and Affiliations

  • Matthieu Malatray
    • 1
  • Sebastien Raux
    • 1
  • Adrien Peltier
    • 1
    • 2
  • Clemence Pfirrmann
    • 1
  • Romain Seil
    • 3
  • Franck Chotel
    • 1
  1. 1.Department of Pediatric Orthopaedic SurgeryHôpital Femme Mere EnfantLyonFrance
  2. 2.Albert Trillat Center, Groupement Hospitalier NordUniversité LyonLyonFrance
  3. 3.Department of Orthopaedic Surgery, Centre Hospitalier-Clinique d’Eich, Luxembourg and Sports Medicine Research LaboratoryLuxembourg Institute of HealthStrassenLuxembourg

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