The anterior and posterior horn insertions of both menisci are fibrous anchor points that hold the menisci to the tibial plateau. The anterior horn of the lateral meniscus and the anterior horn of the medial meniscus are connected by the transverse (intermeniscal) ligament. The posterior horn of the lateral meniscus has an additional attachment to the PCL femoral insertion via the meniscofemoral ligaments (Humphrey and Wrisberg).
| Origin | Anterior and posterior horns and the peripheral rim of the medial and lateral menisci |
|---|---|
| Insertion | Anterior and posterior intercondylar areas of the tibia (root attachments) and the tibial margins just below the articular surface (coronary ligaments) |
Anchor the menisci to the tibia so that they hold their shape and convert axial load into hoop stress
Ramp lesions are tears of the posterior horn of the medial meniscus at its capsular and coronary ligament attachment, a pattern commonly missed on standard MRI sequences and requiring specific sagittal views or arthroscopic probing of the posterior compartment. They are more common with ACL injuries and require inside-out or all-inside suture repair.
Posterior medial meniscal horn detachment from the capsular attachment producing instability not visible on routine MRI requiring arthroscopic assessment and repair.
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