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Gómez Cáceres A, Mariño IT, Martínez Malo FJ, Riestra IV, Idiart RP. Meniscal Ramp Lesion Repair Without the Need for a Posteromedial Portal. Arthrosc Tech 2024; 13:102902. [PMID: 38690339 PMCID: PMC11056648 DOI: 10.1016/j.eats.2023.102902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/01/2023] [Indexed: 05/02/2024] Open
Abstract
Medial meniscal ramp injury has gained the attention of orthopaedic surgeons in recent years. It consists of a tear of the peripheral insertion of the posterior horn of the medial meniscus. Its prevalence in anterior cruciate ligament reconstruction varies between 9% and 40% according to different studies. Ramp lesions cannot always be diagnosed using magnetic resonance imaging scans. To identify ramp lesions, the arthroscope should be introduced into the posteromedial compartment of the knee during the routine examination of the knee (Gillquist maneuver). Not all authors advocate systematically repairing ramp injuries of the medial meniscus, especially when these injuries are small and stable. They have historically been repaired using an outside-in technique using a hook-type suture passed through a posteromedial portal. In this study, we present our all-inside suture technique without the use of a posteromedial portal.
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Affiliation(s)
- Abel Gómez Cáceres
- Departamento de Cirugía Ortopédica y Traumatología, Hospital HM Málaga (Malaga Institute of Sports Traumatology [IMATDE] Málaga), Málaga, Spain
- Novem Clinic, Málaga, Spain
| | - Iskandar Tamimi Mariño
- Departamento de Cirugía Ortopédica y Traumatología, Hospital HM Málaga (Malaga Institute of Sports Traumatology [IMATDE] Málaga), Málaga, Spain
- Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Francisco Javier Martínez Malo
- Departamento de Cirugía Ortopédica y Traumatología, Hospital HM Málaga (Malaga Institute of Sports Traumatology [IMATDE] Málaga), Málaga, Spain
- Hospital Regional Universitario de Málaga, Málaga, Spain
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Kawanishi Y, Kobayashi M, Yasuma S, Fukushima H, Kato J, Murase A, Takenaga T, Yoshida M, Kuroyanagi G, Kawaguchi Y, Murakami H, Nozaki M. Factors Associated With Residual Pivot Shift After ACL Reconstruction: A Quantitative Evaluation of the Pivot-Shift Test Preoperatively and at Minimum 12-Month Follow-up. Orthop J Sports Med 2024; 12:23259671241230967. [PMID: 38414663 PMCID: PMC10898316 DOI: 10.1177/23259671241230967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 02/29/2024] Open
Abstract
Background Postoperative residual rotatory laxity remains despite improvement in surgical techniques for anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose To evaluate factors associated with residual pivot shift after ACLR by quantitative measurement of the pivot shift before and after surgery. Study Design Case-control study; Level of evidence, 3. Methods A total of 97 patients who underwent primary double-bundle ACLR between June 2016 and March 2021 and underwent surgery to remove staples, with at least 12 months of follow-up evaluation, were enrolled. Quantitative measurements were performed under general anesthesia immediately before ACLR (preoperatively), after temporary fixation of the ACL graft (intraoperatively), and immediately before staple removal (postoperatively). The laxity of pivot shift was assessed using inertial sensors to measure acceleration and external rotational angular velocity (ERAV). Descriptive data were assessed for associations with postoperative acceleration and ERAV in a univariate analysis. A multiple linear regression analysis was performed to identify factors associated with postoperative acceleration and ERAV. Results Anterior tibial translation, acceleration, and ERAV increased from intra- to postoperatively (P < .05). Factors significantly associated with postoperative acceleration were age (β = -0.238; P = .021), lateral posterior tibial slope (PTS) (β = 0.194; P = .048), and preoperative acceleration (β = 0.261; P = .008). Factors significantly affecting postoperative ERAV were age (β = -0.222; P = .029), ramp lesions (β = 0.212; P = .027), and preoperative ERAV (β = 0.323; P = .001). Conclusion Greater preoperative laxity in the pivot shift was the factor having the most significant association with residual pivot shift after ACLR using quantitative measurements under general anesthesia. Younger age, higher lateral PTS, and concomitant ramp lesions were significant predictors of residual pivot shift. These findings can help pre- and intraoperative decision-making regarding whether an anterolateral structure augmentation should be added.
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Affiliation(s)
- Yusuke Kawanishi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Makoto Kobayashi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Sanshiro Yasuma
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Hiroaki Fukushima
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Jiro Kato
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Atsunori Murase
- Kasugai Joint & Sports Orthopedic, Pain Clinic, Kasugai, Japan
| | - Tetsuya Takenaga
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Masahito Yoshida
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Gen Kuroyanagi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Yohei Kawaguchi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
| | - Masahiro Nozaki
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-Ku, Nagoya, Japan
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Kim SH, Min K, Kim KI, Lee SH. Clinical and MRI Outcomes of Repaired Peripheral Longitudinal Tears of the Posterior Horn of the Medial Meniscus With ACL Reconstruction: Results According to Tear Size. Orthop J Sports Med 2023; 11:23259671231167535. [PMID: 37655242 PMCID: PMC10467388 DOI: 10.1177/23259671231167535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/17/2023] [Indexed: 09/02/2023] Open
Abstract
Background Arthroscopic repair of longitudinal tears in the medial meniscal posterior horn (MMPH) has been reported to result in high rates of meniscal healing when performed alongside anterior cruciate ligament reconstruction (ACLR). However, studies that have focused on longitudinal tears and their impact on clinical outcomes after arthroscopic repair are insufficient. Purpose To investigate the clinical outcome and healing status after concomitant arthroscopic ACLR and repair of MMPH peripheral longitudinal tears, with respect to the tear length. Study Design Cohort study; Level of evidence, 3. Methods A total of 263 patients who underwent concurrent arthroscopic suture repair of longitudinal tears of the MMPH and ACLR were enrolled. All patients had 2-year postoperative magnetic resonance imaging (MRI) evaluations, and 61% of patients underwent a second-look arthroscopy. The exclusion criteria were partial meniscectomies and multiligament injuries. Patients were assessed pre- and postoperatively for clinical scores, amount of anterior translation, grade of pivot shift, and presence of meniscal tear extension. According to the length of longitudinal tears, patients were classified into 2 groups: (1) patients with tears that were located in the posterior compartment and (2) patients with tears that extended to the midbody of the meniscus. Binary stepwise logistic regression analysis was used to evaluate the risk factors for unhealed menisci as identified by MRI. Results A total of 83 patients were included in this study-52 patients (group 1) had MMPH tears without tear extension and 31 patients (group 2) had MMPH tears with tear extension. There were no differences in outcomes between the groups, including the healing rate after meniscal repair (P > .05). Based on postoperative MRI scans, 67 patients (80.7%) were categorized as completely healed and 16 patients (19.3%) as unhealed. There were no significant differences between the completely healed and unhealed groups in outcomes or the rate of preoperative midbody tear extension. Higher body mass index and lower preoperative Lysholm scores were identified as risk factors for unhealed menisci. Conclusion Overall, the rate of complete healing of MMPH tears repaired concomitantly with ACLR was 80.7% (67/83), and midbody tear extension did not affect the healing rate of the repaired meniscus. Results indicate that suture repair for unstable MMPH tears should be considered regardless of tear size.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Kyeonguk Min
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Kang-Il Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sang Hak Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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Giordano L, Maffulli N, Carimati G, Morenghi E, Volpi P. Increased Time to Surgery After Anterior Cruciate Ligament Tear in Female Patients Results in Greater Risk of Medial Meniscus Tear: A Study of 489 Female Patients. Arthroscopy 2023; 39:613-622. [PMID: 36309227 DOI: 10.1016/j.arthro.2022.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/25/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE This study assessed the incidence of meniscal tears in anterior cruciate ligament (ACL)-deficient knees, considering the time between injury and reconstruction in a large sample of female patients. Furthermore, we evaluated whether the rate of meniscal repair or meniscectomy was affected by age and body mass index (BMI). METHODS The medical records of 489 patients who underwent ACL-reconstructive surgery between January 2011 and April 2021 were analyzed to collect data on the prevalence of meniscal tears, surgical timing, patient age, and BMI. Logistic regression was performed to estimate the association between the prevalence of meniscal tears and the independent variables of surgical timing, age, and BMI. RESULTS Between 24 and 60 months after their injury, female patients showed a statistically significant increase in the presence of associated meniscal lesions when compared with ACL reconstruction performed earlier (odds ratio [OR] of 3.11; 95% 1.06-9.10 confidence interval [CI]), especially for medial meniscal tears, with an OR of 1.94 (95% CI 1.23-3.05, P = .004) between 12 and 24 months. There is a statistically significant difference after 12 months in the rate of meniscal suturing for medial meniscus tears (OR 3.30; CI 1.37-7.91 P = .007). Increasing age was associated with a greater prevalence of meniscal tears up to 30-50 years, but there was no clear association between BMI and associated lesions other than a greater rate of meniscectomies. CONCLUSIONS In female patients who experienced an ACL injury, a delay in surgery greater than 12 months is associated with a gradual increase in the risk of nonrepairable medial meniscal tear; this risk becomes statistically significant after 24 months. A high BMI does not seem to have relevance in the onset of associated lesions in women but results in a greater rate of meniscectomies compared with meniscal sutures, whereas age between 30 and 50 years is associated with a greater risk of associated injuries. LEVEL OF EVIDENCE III, retrospective comparative prognostic trial.
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Affiliation(s)
- Lorenzo Giordano
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy; Centre for Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom; School of Pharmacy and Bioengineering, Keele University School of Medicine, Staffordshire, United Kingdom.
| | - Giulia Carimati
- Knee Surgery and Sport Traumatology Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Piero Volpi
- Knee Surgery and Sport Traumatology Unit, Humanitas Research Hospital, Rozzano, Milan, Italy
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Kawada K, Furumatsu T, Tamura M, Xue H, Higashihara N, Kintaka K, Yokoyama Y, Ozaki T. Effectivity of the Outside-In Pie-Crusting Technique and an All-Inside Meniscal Repair Device in the Repair of Ramp Lesions. Arthrosc Tech 2023; 12:e273-e278. [PMID: 36879867 PMCID: PMC9984773 DOI: 10.1016/j.eats.2022.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/02/2022] [Indexed: 01/20/2023] Open
Abstract
Ramp lesions are characteristic medial meniscus injuries seen in anterior cruciate ligament-injured knees. Anterior cruciate ligament injuries combined with ramp lesions increase the amount of anterior tibial translation and tibial external rotation. Therefore, the diagnosis and treatment of ramp lesions have received increasing attention. However, ramp lesions can be difficult to diagnose on preoperative magnetic resonance imaging. Additionally, ramp lesions are difficult to observe and treat intraoperatively in the posteromedial compartment. Although good results have been reported with the use of a suture hook through the posteromedial portal in the treatment of ramp lesions, the complexity and difficulty of the technique are further problems. The outside-in pie-crusting technique is a simple procedure that can enlarge the medial compartment and facilitate the observation and repair of ramp lesions. After this technique, ramp lesions can be properly sutured, using an all-inside meniscal repair device, without damaging the surrounding cartilage. A combination of the outside-in pie-crusting technique and an all-inside meniscal repair device (with only anterior portals) is effective in the repair of ramp lesions. This Technical Note aims to report in detail the flow of a series of techniques, including our diagnostic and therapeutic methods.
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Affiliation(s)
- Koki Kawada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Masanori Tamura
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Haowei Xue
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Naohiro Higashihara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Yusuke Yokoyama
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
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All-Inside Technique for Ramp Lesion Repair: Arthroscopic Suture With Knee Scorpion Suture Passer. Arthrosc Tech 2022; 11:e2091-e2096. [PMID: 36457398 PMCID: PMC9705918 DOI: 10.1016/j.eats.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/05/2022] [Indexed: 11/07/2022] Open
Abstract
Ramp lesions are peripheral tears of the posterior horn of the medial meniscus that involve the meniscocapsular attachments. They are commonly associated with anterior cruciate ligament injury and frequently not diagnosed. There are several suture techniques for ramp lesions. However, most have a long learning curve to be performed adequately and to minimize the risks of neurovascular lesions, cartilage injury, as well as damage to the meniscotibial ligament and meniscus. Thus, as an alternative to minimize costs and provide adequate ramp lesion repair, we present a simple, easy-to-reproduce technique using a Scorpion Suture Passer and all-inside sutures, without the need to leave devices inside the knee, causing no additional lesions and making it less costly than conventional methods. Our technique, which consists of a biomechanically strong suture, with no internal devices, is cheaper, allows several sutures with the same thread and produces satisfactory clinical results.
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Siboni R, Pioger C, Jacquet C, Mouton C, Seil J, Toanen C, Seil R. Meniscal Ramp Repair: A 2-Portal Posteromedial Approach. Arthrosc Tech 2022; 11:e1163-e1169. [PMID: 35936835 PMCID: PMC9353068 DOI: 10.1016/j.eats.2022.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/10/2022] [Indexed: 02/03/2023] Open
Abstract
The management of medial meniscus ramp lesions can be challenging. The current gold standard technique to repair these lesions is the transnotch view combined with a single instrumental posteromedial portal. However, it does not provide direct visualization of the ramp and does not allow for an anatomic repair. In this Technical Note, a new technique is described with 2 posteromedial portals: a posteromedial viewing portal and working portal. This 2-portal approach aims to improve visualization of the lesion and its repair, as well as allow for a technically easier repair.
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Affiliation(s)
- Renaud Siboni
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg – Clinique d’Eich, Luxembourg
| | - Charles Pioger
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg – Clinique d’Eich, Luxembourg,Department of Orthopaedic Surgery, Ambroise Paré Hospital, Paris Saclay University, Boulogne-Billancourt, France
| | - Christophe Jacquet
- Department of Orthopaedic Surgery and Traumatology, Institute for Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg – Clinique d’Eich, Luxembourg,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg
| | - Julie Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg – Clinique d’Eich, Luxembourg
| | - Cécile Toanen
- Department of Orthopaedic Surgery, Versailles Hospital, 78150, Le Chesnay, France
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg – Clinique d’Eich, Luxembourg,Department of Orthopaedic Surgery, Reims Teaching Hospital, Hôpital Maison Blanche, Reims, France,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg,Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg,Address correspondence to Pr Romain Seil, M.D., Ph.D., Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg – Clinique d’Eich, 78 Rue d’Eich L-1460 Luxembourg.
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Ramp lesion repair via dual posteromedial arthroscopic portals: A cadaveric feasibility study. Orthop Traumatol Surg Res 2022; 108:103175. [PMID: 34906726 DOI: 10.1016/j.otsr.2021.103175] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ramp lesions are found in 16% to 40% of patients undergoing anterior cruciate ligament reconstruction. The repair technique traditionally involves using a suture hook through a posteromedial portal, with the arthroscope positioned in the intercondylar view via an antero-lateral portal. Ramp lesions may be difficult to visualize and repair, even with a 70° arthroscope. The objective of this study was to assess the feasibility of suturing ramp lesions via dual posteromedial portals for the arthroscope and instruments. HYPOTHESIS Dual posteromedial arthroscopic portals allow good visualisation and high-quality suturing of ramp lesions, without inducing specific iatrogenic injuries. MATERIAL AND METHODS We used 11 fresh cadaver knees. Two posteromedial portals were created under visualisation via an arthroscope introduced through an antero-lateral portal: one was the traditional instrumental portal and the other, located more proximally, was the optical portal. A 2-cm long ramp lesion was created. A suture hook was used to place one or two stitches of PDS n°0 suture. A probe was used to test the quality and stability of the suturing. The posteromedial plane was then dissected to evaluate the anatomical relationships of the portals. RESULTS The dual posteromedial approach allowed the visualisation and hook suturing of the ramp lesions in all 11 cases. A single stitch was placed in 4 cases and two stitches in 7 cases. The suture was always of good quality and stable when tested with the probe. The dissection found no injuries to nerves, blood vessels, or tendons. CONCLUSION Ramp lesions can be repaired through a dual posteromedial arthroscopic approach. This surgical technique provides good visibility of these lesions and allows high-quality suturing, with no specific iatrogenic injuries. It is an alternative to ramp lesion repair via a single posteromedial portal, which can be challenging. LEVEL OF EVIDENCE IV, experimental study with no control group.
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Karaca MO, Özbek EA, Ertan MB, Terzi MM, Akmeşe R. Short-Term Outcomes After Treatment of Isolated Hidden Meniscal Ramp Lesions. Orthop J Sports Med 2022; 10:23259671221085977. [PMID: 35386838 PMCID: PMC8977712 DOI: 10.1177/23259671221085977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Ramp lesions are encountered in 16% to 24% of all anterior cruciate ligament
(ACL) ruptures. However, isolated ramp lesions without a ruptured ACL have
also been reported. Purpose: To evaluate outcomes after type 3 hidden ramp lesions without ACL rupture
were treated with all-inside sutures passed through the standard anterior
portal. Study Design: Case series, Level of evidence, 4. Methods: Included were 41 patients (26 female; 63.4%) with isolated type 3 ramp
lesions who underwent surgery between January 2017 and January 2019.
Patients with concomitant lateral meniscal injuries and revision meniscal
surgeries were excluded. We retrospectively recorded patient age, sex, and
body mass index (BMI), as well as follow-up periods, comorbidities, and
postoperative and early midterm complications. The Lysholm, visual analog
scale (VAS) for pain, and International Knee Documentation Committee (IKDC)
scores were compared preoperatively to final follow-up. In addition,
patients were classified as having either a sedentary or active lifestyle
according to Sedentary Behavior Research Network (SBRN) criteria. The
Shapiro-Wilk test was used to evaluate the normality of the data, and the
Wilcoxon and Mann-Whitney U tests were used to compare
preoperative and postoperative outcome scores. The Spearman test was
employed to evaluate the correlation between patient variables. Results: The mean follow-up period was at 37.6 (range, 25-49) months. A total of 17
patients (41.46%) had a sedentary lifestyle based on SBRN criteria. All
scores improved significantly from preoperatively to final follow-up (VAS,
from 8.43 ± 1.53 to 2.34 ± 2.9; Lysholm, from 47.73 ± 17.02 to 85.37 ±
14.01; and IKDC, from 27.12 ± 14.81 to 85.32 ± 8.78; P <
.001 for all). Although no significant relationship was established between
patient activity level and postoperative Lysholm and IKDC scores, an inverse
correlation was observed between BMI and Lysholm (r
=–0.9906) and BMI and IKDC (r =–0.9402). Conclusion: Satisfactory postoperative clinical results were obtained in patients with
type 3 ramp lesions not accompanied by ACL rupture who were treated with
all-inside suturing through standard anterior portals.
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Affiliation(s)
| | - Emre Anıl Özbek
- Department of Orthopedic Surgery, Ankara University, Ankara, Turkey
| | - Mehmet Batu Ertan
- Department of Orthopedic Surgery, Yozgat City Hospital, Yozgat, Turkey
| | | | - Ramazan Akmeşe
- Department of Orthopedic Surgery, Haliç University, Istanbul, Turkey
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Thaunat M, Foissey C, Ingale P, Haidar I, Bauwens PH, Penet A, Kacem S, Fayard JM. Survival and Risk Factor Analysis of Arthroscopic Ramp Lesion Repair During Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2022; 50:637-644. [PMID: 35099318 DOI: 10.1177/03635465211068524] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a lack of research on the management of ramp lesions associated with anterior cruciate ligament (ACL) injuries. Furthermore, there has been no report of the risk factors for failure of ramp lesion sutures, linked to either the technique used (all-inside suture implant vs suture hook through a posteromedial portal) or the type of lesion (location in the red zone or meniscocapsular junction, longitudinal extension, partial- or full-thickness tear). PURPOSE To evaluate the results of arthroscopic repair of ramp lesions and determine the risk factors associated with ramp lesion repair failure, with special focus on their subtype and the suture technique. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS All patients who underwent arthroscopic ramp lesion repair in association with ACL reconstruction between November 2015 and January 2018 were evaluated retrospectively. The following parameters were studied: demographics; clinical history; clinical findings including International Knee Documentation Committee score, complications, time from injury to surgery, side-to-side laxity, and pivot shift; and surgical findings including subtype, surgical management, and type and number of sutures. Failure of the ramp lesion repair was defined at secondary arthroscopy. RESULTS Among the 248 lesions analyzed, 18 (7.3%) failures were documented. The failures occurred in 21.1% of repairs managed with the all-inside device versus 4.3% of sutures managed with the suture hook (P = .003). Among the 6 factors included in the Cox model, the only one identified as a risk factor for failure was the type of repair (P = .003), with a risk for the all-inside device that was >5-fold higher than that for the suture hook repair (corresponding hazard ratio, 5.1 [95% CI, 1.8-14.5]). No other complications involving the surgical technique or device were registered. CONCLUSION An arthroscopic all-inside technique of meniscal repair of ramp lesions appeared to be safe and effective. It provided excellent healing of the repaired meniscus, with an overall failure rate of 7.3%. The type of suture was associated with failure of the ramp lesion repair, with a significantly higher risk with the all-inside device than with suture hook repair sutures.
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Affiliation(s)
- Mathieu Thaunat
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Constant Foissey
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Pramod Ingale
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Ibrahim Haidar
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Paul Henri Bauwens
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Alexandre Penet
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Samih Kacem
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
| | - Jean-Marie Fayard
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center, Lyon, France
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Keyhani S, Vaziri AS, Vosoughi F, Verdonk R, Movahedinia M. Overview of Posterior knee arthroscopy in the medial meniscal repair: technical note. J ISAKOS 2022; 7:33-38. [DOI: 10.1016/j.jisako.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
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Isolated Meniscotibial Ligament Rupture: The Medial Meniscus "Belt Lesion". Arthrosc Tech 2022; 11:e133-e138. [PMID: 35155104 PMCID: PMC8821026 DOI: 10.1016/j.eats.2021.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/29/2021] [Indexed: 02/03/2023] Open
Abstract
Ramp lesions play a major role in both anteroposterior and rotational instability following anterior cruciate ligament rupture. The meniscotibial ligament (MTL) is the most important structure to repair and is the primary stabilizer of the posterior horn of the medial meniscus. The posteroinferior insertion of the MTL on the posterior horn of the medial has been described, forming a posterior "belt." Isolated MTL lesion diagnosis can be challenging, as the absence of a meniscocapsular ligament lesion prevents its correct visualization through transnotch vision. This article details a technique to diagnose and repair the "belt lesion" of the medial meniscus.
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Leaving the stable ramp lesion unrepaired does not negatively affect clinical and functional outcomes as well as return to sports rates after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2021; 29:3773-3781. [PMID: 33452579 DOI: 10.1007/s00167-020-06402-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 12/07/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the effects of untreated stable ramp lesions on clinical and functional outcomes, return to sports rates, and complications of patients who underwent anterior cruciate ligament reconstruction. METHODS A total of 879 patients with anterior cruciate ligament rupture were evaluated. Of these, 66 patients [33 patients with anterior cruciate ligament rupture and stable medial meniscal ramp lesion (ramp + group) and 33 patients with isolated anterior cruciate ligament rupture (ramp - group)] with a minimum 3-year of follow-up were included. Stable ramp lesions were not repaired in the ramp + group. Preoperative and postoperative Lachman and pivot-shift grades, Lysholm knee scores, International Knee Documentation Committee score and 12-Item Short Form Health Survey score were compared between groups. The return to sports rates, level of return to sports, time to return to sports and complications were compared. RESULTS The mean patient age was 27.8 ± 7.2 years. The mean follow-up period was 47.3 ± 9.4 months. There were no significant differences between groups regarding preoperative and postoperative Lachman and pivot-shift grades, 12-Item Short Form Health Survey mental and physical component summary scores, Lysholm and International Knee Documentation Committee scores, and complication rates (n.s.). Although the return to sports rates (84.8% vs 90.1%) and the level of the return to sports (return to preinjury level: 75% vs 78%) were similar between groups (n.s.), the time to return to sports was significantly longer for patients with ramp lesions (11.1 ± 4.0 vs. 8.7 ± 2.5 months, p = 0.007). CONCLUSION Leaving the stable ramp lesion unrepaired does not negatively affect clinical and functional outcomes as well as return to sports rates after ACL reconstruction. However, the time to return to sports is prolonged in patients with ramp lesions In clinical practice, surgeons should be aware that repairing stable ramp lesions is not an absolute necessity and will not affect return to sport rates. LEVEL OF EVIDENCE Level III.
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Choi KY, Koh IJ, Kim MS, In Y. Medial Meniscal Ramp Lesion Repair Through Anterior Portals Using a Medial Collateral Ligament Pie-Crusting Technique. Arthrosc Tech 2021; 10:e1073-e1077. [PMID: 33981553 PMCID: PMC8085387 DOI: 10.1016/j.eats.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/15/2020] [Indexed: 02/03/2023] Open
Abstract
Ramp injury, that is, injury to the peripheral attachment of the posterior horn of the medial meniscus, often requires additional surgery during anterior cruciate ligament (ACL) reconstruction. Diagnosis and treatment of ramp lesions are important because unrepaired ramp lesions could cause risk to the reconstructed ACL because of anteroposterior and external rotation laxity, whereas acute rupture or chronic deficiency of the ACL could also cause ramp lesions because of instability. Ramp lesions are difficult to diagnose and treat from the anterior compartment during arthroscopy. Typically, this repair requires technically demanding skills and is performed from the posterior portal using a suture hook under visualization with the arthroscope through the intercondylar notch. Inexperienced surgeons often struggle with using the posterior portal and the suture hook. Our all-inside repair technique using the FasT-Fix system (Smith & Nephew, Andover, MA) under direct visualization from the anterior compartment accompanied by a medial collateral ligament pie-crusting technique facilitates repair of ramp lesions without causing medial instability.
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Affiliation(s)
- Keun Young Choi
- Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Jun Koh
- Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Man Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong In
- Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Address correspondence to Yong In, M.D., Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
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Sonnery-Cottet B. Editorial Commentary: Ramp Lesion: The Eye Sees Only What the Mind Is Prepared to Comprehend. Arthroscopy 2020; 36:2934-2937. [PMID: 33172589 DOI: 10.1016/j.arthro.2020.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 02/02/2023]
Abstract
If our consciousness is not prepared, it is difficult to identify a ramp lesion on preoperative magnetic resonance imaging due to its low sensitivity. In clinical practice, the prevalence of ramp lesion in the anterior cruciate ligament (ACL)-injured knee can be up to 30%, with an increased frequency in chronic ACL injuries and in revision ACL. To identify the ramp lesion, routine arthroscopic exploration of the posteromedial portion of knee using a trans-notch view during ACL reconstruction therefore seems essential. A decrease in reoperation rate for secondary meniscectomy from 25% to 7% since 2013 was published by our department, after the adoption of a systematic repair through a posteromedial portal with a suture hook device for ramp lesions identified at the time of ACL reconstruction.
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