Anterior cruciate ligament (ACL) injuries are often seen in conjunction with meniscus tears; some of these tears are critical for knee stability, although they can make diagnosis difficult. Ramp lesions of the medial meniscus and zip lesions of the lateral meniscus are examples of this type of injury that require careful arthroscopic evaluation. A 27-year-old male patient presented with pain and instability in his right knee following an injury sustained during football one year prior. Magnetic resonance imaging revealed an ACL tear and a suspected tear in the medial meniscus; however, the lateral meniscus lesion could not be clearly defined preoperatively.
During arthroscopy, the ACL tear, ramp lesion in the medial meniscus, and zip lesion in the lateral meniscus were confirmed. ACL reconstruction was performed using a hamstring autograft. The ramp lesion was repaired with all-inside sutures. A partial meniscectomy was performed on the peripheral zip lesion, and an all-inside repair was applied to the menisco-capsular tear. Ramp and zip lesions are difficult to diagnose both before and during surgery and they may coexist. Adequate repair of these lesions is integral for long-term results, thus the surgeon should approach these lesions carefully and patiently.