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 of follow-up.

All patients who underwent arthroscopic ACLRs 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, lesion was left in situ, without suture or debridement. The following parameters were studied: demographics; history and clinical findings including time from injury to surgery, side-to-side laxity, pivot shift; knee and activity function by Lysholm score, subjective IKDC, KOOS and Tegner activity scale; and evolution to bucket handle. We defined two groups: bucket handle group versus no bucket handle group.

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. The occurrence of medial meniscus bucket handle represented 21.4% of our population, with an average delay of 99 (±50) months, and a concentration of this injury between 96 and 156months. The postoperative scores were significantly improved for the whole population at more than 20years of follow-up (P<0.0001), except for the Tegner score (P=0.3424). Functional scores and side-to-side laxity was the same for the two groups. No risk factors were identified.

There is a high incidence of bucket-handle injury after ACL surgery with a ramp lesion left in place (21.4%). This high rate is only found in series with a long follow-up, since these lesions appear between 8 and 12years after the first surgery.