Concomitant Lateral Meniscal Tears in Pediatric and Adolescent Patients Undergoing Combined Medial Meniscal Ramp Lesion Repair and Anterior Cruciate Ligament Reconstruction Are Frequently Missed on MRI, Are Often Vertical or Root Tears, and Are Usually Repaired: A Multicenter Study.

Background: In pediatric and adolescent patients with medial meniscal ramp lesions (MMRLs) undergoing anterior cruciate ligament reconstruction (ACLR), the presence of concomitant lateral meniscal tears (LMTs) are not well-characterized. Purpose: To describe the characteristics and surgical management of concomitant LMTs in pediatric and adolescent patients undergoing MMRL repair during primary ACLR. Study Design: Case series; Level of evidence, 4. Methods: Patients <18 years old who underwent an MMRL repair during primary ACLR at 5 institutions from 2013 to 2025 were included. All MMRLs were diagnosed arthroscopically and defined as a partial or complete peripheral vertical/longitudinal tear of the posterior horn of the medial meniscus at or ≤3 mm from the meniscocapsular junction. The presence, location, and surgical management of arthroscopically identified concomitant LMTs were gathered from the operative reports. Lateral meniscus root tears (LMRTs) were categorized using the LaPrade classification. Patients with and without concomitant LMT at the time of MMRL repair during primary ACLR were compared. Results: In total, 189 pediatric and adolescent patients underwent an MMRL repair during primary ACLR at a mean age of 16.1 ± 1.4 years (range, 12.0-17.9 years). Concomitant LMTs were arthroscopically diagnosed in 122 (65%) patients, of which 38 (31%) were missed on the initial preoperative magnetic resonance imaging (MRI) report. Surgically, the majority of concomitant LMTs (67%) were treated with repair while 27% were treated with partial meniscectomy or observation (6%). LMTs were most frequently localized to the posterior horn (61%) or posterior root (27%). The most common LMT morphology was vertical/longitudinal (41%), followed by LMRTs (25%), complex nonroot tears (15%), radial tears (12%), and bucket-handle tears (4%). Of the 31 LMRTs identified, type 4 complex oblique root tears were most prevalent (65%), followed by type 2 complete radial root tears (26%), type 1 partial stable root tears (6%), and a type 5 bony root avulsion (3%). Significant risk factors associated with the presence of a concomitant LMT included male sex (odds ratio [OR], 1.9; 95% CI, 1.0-3.7; Conclusion: In this multicenter study, 65% of pediatric and adolescent patients undergoing MMRL repair during primary ACLR had a concomitant LMT and the majority were localized to the posterior horn and posterior root. As 31% of concomitant LMTs were missed on preoperative MRI, the posterior aspect of the lateral meniscus should be carefully evaluated at the time of surgery in pediatric patients with MMRLs. Nearly half of the concomitant LMTs identified in this cohort were LMRTs, complex tears, complete radial tears, or bucket-handle tears. Overall, surgeons should anticipate performing an additional lateral meniscal repair in nearly half of pediatric patients undergoing an MMRL repair during primary ACLR.