Introduction: Meniscocapsular separation or Ramp lesions have been reported to be associated with ACL injuries however, no study has been conducted on an Indian population to find out its incidence and extent. Aim: This study investigates the incidence of Ramp Lesions in Indian Patients with ACL injury; the extent of lesion and need for repair. We also attempt to assess the sensitivity of MRI in detecting these lesions. Methods: This study was a prospective case series and all patients undergoing ACL reconstruction (ACLR) from Oct 2017- Oct 2018 were included. The patients’ MRI were evaluated for signs of Ramp lesion. During arthroscopy the posteriomedial compartment was visualized through the standard anterolateral portal using the trans notch maneuver. If a Ramp lesion was identified, it was classified based on extent and location. A postero medial portal was created to probe the extent of the lesion and repaired with fibre wire sutures, if required. A standard operating technique and postoperative rehab protocol was implemented in all the cases of ACLR with or without ramp lesions. Results: Ramp lesion was identified in 10 patients (11.5%) during diagnostic arthroscopy (n= 87). MRI was only 30 % sensitive in identifying ramp lesions (3/10). 7 of the lesions were associated with separation of the mensicotibial ligament on probing and were repaired using fibre wire sutures. The rest 3 lesions were partial lesions with meniscotibial ligament not completely separated and were stable on probing, these weren’t repaired. Conclusions: MRI isn’t reliable in diagnosing Ramp lesions preoperatively. All patients undergoing ACLR must have their posterior compartment visualized and a posteromedial portal is essential to probe and repair Ramp lesions. The presence of mensicotibial ligament separation can be used as a guide to decide which lesions to repair.
