Incidence and Treatment Strategy of Lateral Meniscus Posterior Root Tears and Ramp Lesions Identified During Isolated ACL Reconstructions: Report From a Nationwide Knee Ligament Register

Background: Meniscus repair is increasingly common during primary anterior cruciate ligament reconstruction (ACLR), particularly because of an increased focus on the severity of untreated lateral meniscus posterior root tears (LMPRTs) and ramp lesions. However, the incidence and current treatment strategies for these injuries across a larger population remain unclear as previous reports come from selective cohort studies. Purpose: To report on the incidence of LMPRTs and ramp lesions in primary ACLR in Norway, compare patient- and activity-related characteristics in those with and without these injuries, and describe current treatment strategies. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Data from the Norwegian Knee Ligament Register (2018-2023) were analyzed. The study included patients undergoing isolated ACLR. Sex, age, weight, preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) scores, sports participation, and meniscus treatment strategy were considered. Winter sports exhibited the highest sport-specific incidence of LMPRTs (14.3%) and ramp lesions (14.2%). LMPRT treatment predominantly involved transtibial suturing with cortical fixation, while ramp lesion management was split between all-inside and other suturing techniques (including repairs through a posteromedial portal). Conclusion: This first nationwide registry study identified a high incidence of concomitant meniscus tears in ACLR, with incidences of LMPRTs and ramp lesions of 10.0% and 7.8%, respectively. Patients with ramp lesions were significantly younger than both those with LMPRTs and those without meniscus injuries. Treatment for LMPRTs predominantly involved transtibial sutures with cortical fixation, while treatment for ramp lesions was divided between all-inside suturing techniques and other suturing methods (including repairs through a posteromedial portal).