Two radiologists (MZ and SG, with 13 and 2 years’ experience in musculoskeletal imaging, respectively), blinded to orthopedic assessment, independently assessed MR images. They were asked to assess each structure of the posteromedial meniscocapsular complex on sagittal PD or IW fat saturated sequences. Criteria for diagnosing tears of those structures were:

Ramp lesion: when the concave band (ramp capsule) with low signal intensity posterior to the posterior horn of the medial meniscus was interrupted by a line of hyperintensity crossing this capsular reflection Fig. Fig.33a–c;

Meniscotibial ligament lesion: when the ligament appeared interrupted and hyperintense, with a fluid line extending close to the posterior margin of tibial plate, having an acute angle appearance while having lost the normal curved and concave shape Fig. Fig.44a–c;

Peripheral meniscal lesion: when a vertical or oblique hyperintense line was identified in the posterior third of the posterior horn of medial meniscal fibrocartilage (1–3 mm from the meniscocapsular junction) Figs. Figs.55a–c

The association of more type of lesions was assessed Fig. Fig.6a–c.6a–c. The presence of bone bruise edema of the posteromedial tibial plate was also assessed. Lesions were graded as present or absent.

a–c Drawing a, PDw fat sat sagittal MR b and arthroscopy c images of the same patient, show the association of more lesions. Ramp lesion (arrow), peripheral meniscal oblique lesion (dotted arrows), and meniscotibial ligament tear (arrowheads)

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