Bony injury associated with ramp lesion and a double meniscal injury - A hidden terrible triad of the posteromedial knee

Ramp lesions are important injuries that are difficult to detect on MRI and pose a challenge to diagnose on arthroscopy since they require inspection of the posteromedial compartment. No bony injury has been reported in the literature as an associated injury with the ramp lesion. We report a rare case of complete ramp tear of the posterior capsule-meniscal junction associated with fracture of the rim of the posterior medial tibial plateau and a double injury to the posterior medial meniscus forming a terrible triad with poor prognosis. This report has implications on the classifications of ramp lesions, posterior root injuries of the medial meniscus and meniscal tears as fracture of the rim adds a new dimension to these injuries.