Prevalence and Risk Factors for Medial Meniscus Ramp Lesions in the Setting of Pediatric Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis

Jay Moran; Michael S Lee; Scott Fong; Christopher LaPrade; Kyle N Kunze; Peter D Fabricant; Jorge Chahla; Andrew E Jimenez; Robert F LaPrade

doi:10.1097/BPO.0000000000002900

Prevalence and Risk Factors for Medial Meniscus Ramp Lesions in the Setting of Pediatric Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis

J Pediatr Orthop. 2025 Jan 22. doi: 10.1097/BPO.0000000000002900. Online ahead of print.

Authors

Jay Moran¹, Michael S Lee¹, Scott Fong¹, Christopher LaPrade², Kyle N Kunze³, Peter D Fabricant³, Jorge Chahla⁴, Andrew E Jimenez¹, Robert F LaPrade³

Affiliations

¹ Department of Rehabilitation and Orthopedics, Yale School of Medicine, New Haven, CT.
² Twin Cities Orthopedics, Edina, MN.
³ Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
⁴ Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.

PMID: 39840766
DOI: 10.1097/BPO.0000000000002900

Abstract

Background: Medial meniscus ramp lesions (MMRLs) are commonly associated with anterior cruciate ligament (ACL) injuries and may increase the risk of graft failure after ACL reconstruction (ACLR) if undiagnosed or left untreated. Although MMRLs have been extensively reported in adults, there are limited studies describing them in pediatric patients undergoing ACLR. The purpose of this study was to perform a systematic review and meta-analysis to determine the pooled prevalence of and risk factors for MMRLs in pediatric patients with ACL injuries.

Methods: PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were queried in December 2023 for studies reporting on MMRLs in pediatric patients (≤21 y old) undergoing ACLR. Articles were only included if they reported on the prevalence and/or risk factors for arthroscopically diagnosed MMRLs. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and MMRLs by generating effect estimates in the form of odds ratios (OR) with 95% CI.

Results: Seven studies were identified, which included 1362 pediatric patients (mean±SD age, 15.3±1.4 y old) that underwent ACLR. The pooled MMRL prevalence was 16.4% (range, 13.2% to 28%) calculated across 6 studies. Of the 7 studies identified, 5 qualified for the risk factor analysis, which included a total of 536 ACLR patients. Twenty risk factors were identified, of which 8 were amenable to being explored quantitatively. Anterolateral ligament (ALL) injuries on magnetic resonance imaging (MRI) [odds ratio (OR), 4.16; 95% CI, 1.40-12.34; P=0.01], MMRLs on preoperative MRI (OR, 4.09; 95% CI, 2.52-6.64; P<0.00010), posteromedial tibial plateau bone marrow edema (OR, 2.11; 95% CI, 1.16-3.83; P=0.01), and concomitant lateral meniscus tears (OR, 1.70; 95% CI, 1.04-2.76; P=0.03) were important risk factors for pediatric MMRLs. Skeletal maturity (physes open or closed), male sex, or collateral ligament injury was not associated with the presence of pediatric MMRLs.

Conclusion: The overall pooled prevalence of MMRLs was 16.4% in pediatric patients undergoing ACLR. Significant risk factors for pediatric MMRLs included the presence of concomitant ALL injuries on MRI, identification of MMRLs on MRI, posteromedial tibia plateau bone marrow edema, and concomitant lateral meniscus tears at the time of surgery. Skeletal maturity, male sex, or collateral ligament injury were not associated with MMRLs in pediatric ACL tears.

Level of evidence: Systematic review and meta-analysis; level of evidence: IV.