The perimeniscal fluid, edema of the posterior capsule, or even normal structures can be mistaken for a ramp lesion.
Let's look at the normal meniscocapsular junction and find out the difference between these lesions and ramp lesions.
The meniscocapsular junction of the posterior horn of medial meniscus is composed of the meniscocapsular ligament superiorly and the meniscotibial ligament inferiorly, both of which attach peripherally into the posterior horn of the medial meniscus.
(normal meniscocapsular junction) There can be heterogeneous high signal on FSPD images (or T2-weighted images) at the meniscocapsular margin due to tissue inhomogeneity or peripheral vessels.
(perimeniscal fluid) There is a large amount of joint fluid, so there is perimeniscal fluid occupying the posterior aspect of the medial meniscus and the upper surface of the medial tibial plateau.
It looks like the fluid fill-cleft seen in the ramp type 4B lesion, but the meniscotibial and meniscocapsular ligaments are clearly visible, and there is no edema at the meniscocapsular junction.
(edema of posterior capsule) Edema of the meniscocapsular junction of the posterior horn is one of the most frequent findings in type 4B lesions, but the presence of mild edema alone was not enough to make a diagnosis of a ramp lesion.
This MRI finding represents a sprain rather than a true ramp lesion or meniscocapsular separation.
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