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Liu F, Sun H, Li D, Huang J, Chen M, Lin X, Xu J, Ma R. DLL1/NOTCH1 signaling pathway maintain angiogenesis in meniscus development and degeneration. Int J Biochem Cell Biol 2024; 172:106589. [PMID: 38772475 DOI: 10.1016/j.biocel.2024.106589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/05/2024] [Accepted: 05/10/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES The decline in vascular capacity within the meniscus is a well-documented phenomenon during both development and degeneration. Maintaining vascular integrity has been proposed as a potential therapeutic strategy for osteoarthritis. Therefore, our study aims to investigate the characteristics of endothelial cells and blood vessels in embryonic and degenerated meniscus tissues. METHODS Human embryonic and mature menisci were used for histological analyses. Single-cell RNA sequencing was used to identify cell clusters and their significant genes in embryo meniscus to uncover characteristic of endothelial cells. Computer analysis and various staining techniques were used to characterize vessels in development and osteoarthritis meniscus. RESULTS Vessels structure first observed in E12w and increasing in E14w. Vessels were veins majorly and arteries growth in E35w. Endothelial cells located not only perivascular but also in the surface of meniscus. The expression of DLL1 was observed to be significantly altered in endothelial cells within the vascular network that failed to form. Meniscus tissues affected by osteoarthritis, characterized by diminished vascular capacity, displayed reduced levels of DLL1 expression. Experiment in vitro confirmed DLL1/NOTCH1 be vital to angiogenesis. CONCLUSION Lack of DLL1/NOTCH1 signaling pathway was mechanism of vascular declination in development and degenerated meniscus.
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Affiliation(s)
- Fangzhou Liu
- All listed authos are from Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Hao Sun
- All listed authos are from Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Deng Li
- All listed authos are from Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Junming Huang
- All listed authos are from Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Meiyi Chen
- All listed authos are from Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Xiaobin Lin
- All listed authos are from Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Jie Xu
- All listed authos are from Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China.
| | - Ruofan Ma
- All listed authos are from Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China.
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Allende F, Berreta RS, Allahabadi S, Mowers C, Russo R, Palco M, Simonetta R, Familiari F, Chahla J. Meniscal ramp lesion classification systems: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024; 32:1710-1724. [PMID: 38666656 DOI: 10.1002/ksa.12188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE To describe the proposed classification systems for meniscal ramp lesions (RLs) in the literature and evaluate their accuracy and reliability. METHODS A systematic search was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines utilising PubMed, Embase and Cochrane Library databases. Level I-IV studies referencing RLs along with either an arthroscopic- or magnetic resonance imaging (MRI)-based classification system used to describe RL subtypes were included. RESULTS In total, 21 clinical studies were included. Twenty-seven (79%) of the included studies were published in 2020 or later. There were four main classification systems proposed within the literature (two arthroscopic-, two MRI-based), describing tear patterns, mediolateral extent, associated ligament disruption and stability of the lesion. The first classification was proposed in 2015 by Thaunat et al. and is referenced in 22 (64.7%) of the included studies. The application of the Thaunat et al. criteria to MRI showed variable sensitivity (31.70%-93.8%) and interobserver agreement (k = 0.55-0.80). The Greif et al. modification to the Thaunat et al. system was referenced in 32.4% of the included studies and had a substantial interobserver agreement (k = 0.8). Stability to probing and specific tear location were each used to classify RLs in 28.6% and 23.8% of the included clinical studies, respectively. CONCLUSION Although there has been a recent increase in the recognition and treatment of meniscal RLs, there is limited consistency in descriptive classifications used for this pathology. Current RL classification systems based on preoperative MRI have variable reliability, and arthroscopic examination remains the gold standard for diagnosis and classification. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Felicitas Allende
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, USA
| | - Rodrigo Saad Berreta
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, USA
| | - Sachin Allahabadi
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, USA
| | - Colton Mowers
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, USA
| | - Raffaella Russo
- Department of Orthopedics, Magna Graecia University of Catanza, Catanzaro, Italy
| | - Michelangelo Palco
- Department of Orthopedics, Magna Graecia University of Catanza, Catanzaro, Italy
| | - Roberto Simonetta
- Department of Orthopedics, Magna Graecia University of Catanza, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopedics, Magna Graecia University of Catanza, Catanzaro, Italy
| | - Jorge Chahla
- Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, USA
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Lambrey PJ, Fayard JM, Graveleau N, Toanen C, Noailles T, Letartre R, Barth J, Cavaignac E, Bouguennec N, Thaunat M. Risk factors and prevalence of ramp lesions in ACL ruptures: An analysis from the registry of the Francophone Arthroscopic Society. Knee Surg Sports Traumatol Arthrosc 2024; 32:1700-1709. [PMID: 38655742 DOI: 10.1002/ksa.12194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE The study aimed to estimate the prevalence of ramp lesions among patients undergoing anterior cruciate ligament (ACL) reconstruction and identify risk factors associated with these lesions. METHODS A retrospective, multicentre cohort study was conducted using data from the Francophone Arthroscopic Society's registry, including 5359 patients who underwent ACL reconstruction (ACLR) from June 2020 to June 2023. Potential risk factors for ramp lesion such as patient demographics, revision surgery, pivot shift, side-to-side anteroposterior laxity, medial collateral ligament (MCL) injury, lateral meniscal tear and the volume of ligament remnant were evaluated using multivariate regression analyses. BMI and delay to surgery were also assessed. RESULTS Ramp lesions were identified in 822 patients (15.3%). Univariate analysis identified male sex, younger age, revision surgery, lateral meniscal injury, percentage of ACL remnant (all p < 0.0001) and pivot shift (p = 0.0103) as significant risk factors. MCL injury was associated with a lower risk (p < 0.0001). In multivariate analysis, male sex, younger age, revision surgery, lateral meniscal injury and percentage of ACL remnants remained significant risk factors, while MCL injury remained a protective factor. The anteroposterior laxity wasn't a significant predictor in either analysis. In subgroup analysis, there were no differences concerning body mass index (n.s) and the delay to surgery (n.s). CONCLUSION The study identified male sex, younger age, revision surgery, lateral meniscal injury and pourcentage of ACL remnant as significant risk factors for ramp lesions, with MCL injury acting as a protective factor. This will help regarding the suspicion and identification of ramp lesions. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Pierre-Jean Lambrey
- Ramsay Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | - Jean-Marie Fayard
- Ramsay Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
| | | | - Cécile Toanen
- Service de Chirurgie Orthopédique, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Thibaut Noailles
- Département de Chirurgie Orthopédique, Polyclinique de Bordeaux Nord, Bordeaux, France
| | | | | | | | | | - Mathieu Thaunat
- Ramsay Santé, Hôpital privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Center of Excellence, Lyon, France
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Lindqvist Bueneman S, Sernert N, Kvist J, Kartus JT. Analysis of the Swedish Knee Ligament Register: Concomitant injuries, revision surgery and smoking render worse results. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38869078 DOI: 10.1002/ksa.12307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/06/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE To analyse the 52,199 patients in the Swedish Knee Ligament Register (SKLR) preoperatively, and the patients reaching 5- and 10-year follow-ups who underwent anterior cruciate ligament reconstruction (ACLR), revision ACLR and ACLR on the contralateral side (CACLR). The main hypothesis was that patients undergoing revision ACLR would have worse patient-reported outcome measurements (PROMs) than the primary ACLR group at 10 years and that smoking and concomitant injuries would result in poorer outcomes for all groups. METHODS Data from 2005 to 2021 were extracted from the SKLR. Only patients whose ACLR surgery was registered in the SKLR were included for revision ACLR and CACLR. The PROMs consist of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the knee-specific PROM (EQ-5D-3L). PROMs were analysed as a whole and in subgroups based on sex, smoking, graft choice and concomitant injuries. RESULTS Poorer KOOS were seen for revisions compared with primary ACLRs at both the 5- and 10-year follow-ups (p = 0.003). Smokers had significantly poorer KOOS than nonsmokers (p < 0.001) preoperatively in all groups, however only in the primary ACLR group at 5 and 10 years. At 10 years, patients who had undergone CACLR had lower KOOS than primary ACLRs (p = 0.03). Concomitant injuries resulted in statistically, significantly poorer KOOS for both primary ACLRs and CACLRs preoperatively and at the follow-ups. CONCLUSION The PROMs for revision ACLRs have worse KOOS scores at 10 years compared with the primary ACLRs. The presence of concomitant meniscal or cartilage injuries at the time of ACLR or CACLR were associated with worse PROMs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sofia Lindqvist Bueneman
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Orthopaedics, NU Hospital Group, Uddevalla, Sweden
| | - Ninni Sernert
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
| | - Joanna Kvist
- Department of Health, Medicine and Caring Science, Division of Physiotherapy, Linköping University, Linköping, Sweden
- Department of Molecular Medicine & Surgery, Stockholm Sports Trauma Research Center, Karolinska Institute, Stockholm, Sweden
| | - Jüri-Toomas Kartus
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Orthopaedics, NU Hospital Group, Uddevalla, Sweden
- Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
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Tang Z, Luo Y, Liu D, Zhou S, Xu Z, Zhu T, Yang H. Investigation of the anatomic risk factors in acute anterior cruciate ligament ruptures to develop ramp lesions of the medial meniscus by quantitative MRI. Insights Imaging 2024; 15:133. [PMID: 38825662 PMCID: PMC11144682 DOI: 10.1186/s13244-024-01685-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/02/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE To investigate the anatomic risk factors of knee in patients with acute non-contact anterior cruciate ligament (aACL) ruptures to develop ramp lesions. METHODS A total of 202 subjects were retrospectively divided into three groups: (1) aACL ruptures combined with ramp lesions group (n = 76); (2) isolated ACL ruptures group (n = 56) and (3) normal controls group (n = 70). Quantitative morphological parameters on MRI were measured including: diameter of medial femoral condyle (MFC), anterior-posterior length and depth of medial tibial plateau (MTP AP length and depth), lateral posterior tibial slope (LPTS) and medial posterior tibial slope (MTPS), asymmetry of LPTS and MPTS (LMPTS), lateral meniscal slope (LMS), and medial meniscal slope (MMS). RESULTS The MTP AP length, MTP AP length/MFC diameter ratio, MTP depth, LPTS and the asymmetry of LMPTS showed significant differences among the three groups (p < 0.001). The risk factors associated with the ramp lesions including a longer MTP AP length (OR 1.17, 95% CI 1.00-1.44, p = 0.044), increased MTP depth (OR 1.91, 95% CI 1.22-3.00, p = 0.005) and lager ratio (OR 1.11, 95% CI 1.01-1.22, p = 0.036). The highest AUC was the MTP AP length/MFC diameter ratio (0.74; 95% CI, 0.66-0.82). The combination model increased higher accuracy (0.80; 95% CI, 0.72-0.88). CONCLUSION Several bony anatomic characteristics of the knee, especially the morphology of medial tibia plateau, are additional risk factors for aACL ruptures to develop ramp lesions. CRITICAL RELEVANCE STATEMENT Predictive anatomic risk factors of the knee for patients with acute non-contact anterior cruciate ligament (aACL) ruptures to develop ramp lesions, especially the morphology of medial tibia plateau, are detectable by MRI. KEY POINTS Ramp lesion development can complicate aACL ruptures and requires specific treatment. Longer AP length and increased MTP depth are risk factors for concurrent ramp lesions. Identification of ramp lesions allows for the most appropriate treatment.
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Affiliation(s)
- Ziyi Tang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yuxi Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Dan Liu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Suying Zhou
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhangyan Xu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Tongxin Zhu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - HaiTao Yang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Dingel AB, Tompkins M, Yen YM, Karius AK, Cinque M, Vuong BB, Taylor V, Pham NS, Ganley TJ, Wilson P, Ellis HB, Green D, Fabricant PD, Boucher L, Shea KG. A Recess Is Observed Between the Posterior Knee Capsule and the Meniscotibial Ligament Complex in Pediatric Specimens. Arthrosc Sports Med Rehabil 2024; 6:100852. [PMID: 39006787 PMCID: PMC11240032 DOI: 10.1016/j.asmr.2023.100852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 11/19/2023] [Indexed: 07/16/2024] Open
Abstract
Purpose To define the surgical anatomy of the meniscotibial ligament complex of the pediatric medial and lateral menisci and their relation to the proximal tibial physis and posterior joint capsule. Methods Fourteen pediatric cadaveric knee specimens (aged 3 months to 11 years) were dissected to clarify the relation of the posterior knee capsule, the meniscus, and the meniscotibial ligament complex. Metallic markers were placed marking the meniscotibial ligament capsular attachment on the proximal tibia. Specimens underwent computed tomography scanning to evaluate pin placement and relation to the physis. A digital measurement tool was used to measure the distances between the proximal tibial physis and the pins (placed at 5 points on both the lateral and medial menisci). Results In each specimen, clear separation was noted between the posterior joint capsule from the meniscus and meniscotibial ligament complex in the medial and lateral compartments. There was an increase in the distance between the proximal tibial physis and the insertion points of the meniscotibial ligament complex with increasing specimen age. For both the medical and lateral menisci in group 1, the median meniscotibial ligament insertion points were often less than 7 mm (interquartile range, 0.00-7.8 mm) away from the physis. The median meniscotibial ligament insertion points in group 2 tended to be farther from the physis but always less than 20 mm (interquartile range, 2.5-17.5 mm)-and as close as less than 5 mm (lateral posterior root). Conclusions In this anatomic study of pediatric knees, we observed a distinct recess/cul-de-sac space between the posterior knee capsule and meniscal attachments in all specimens. This defines a distinct plane between the posterior knee capsule and the meniscotibial ligament complex, with a distance between the physis and meniscotibial ligament capsular attachments that increases with age. Clinical Relevance The anatomic parameters evaluated in our study should be considered as future meniscal repair and transplantation techniques aim to restore the meniscal anatomy, stability, and mobility provided by the meniscotibial ligament complex and capsule structures.
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Affiliation(s)
- Aleksei B. Dingel
- School of Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Marc Tompkins
- TRIA Orthopaedic Center, Minneapolis, Minnesota, U.S.A
- University of Minnesota, Minneapolis, Minnesota, U.S.A
- Gillette Children’s Specialty Healthcare, St. Paul, Minnesota, U.S.A
| | - Yi-Meng Yen
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, U.S.A
| | | | - Mark Cinque
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Brian B. Vuong
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Vanessa Taylor
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Nicole S. Pham
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
| | - Theodore J. Ganley
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A
| | | | | | - Daniel Green
- Pediatric Orthopaedic Surgery Division, Hospital for Special Surgery, New York, New York, U.S.A
| | - Peter D. Fabricant
- Pediatric Orthopaedic Surgery Division, Hospital for Special Surgery, New York, New York, U.S.A
| | - Laura Boucher
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, U.S.A
| | - Kevin G. Shea
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, U.S.A
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Aman ZS, Blaber OK, R McDermott E, DeFoor MT, DePhillipo NN, Dickens JF, Dekker TJ. Acute Anterior Cruciate Ligament Reconstruction Performed Within 10 Days of Injury Does Not Increase Risk of Postoperative Arthrofibrosis: A Systematic Review and Meta-analysis. Am J Sports Med 2024; 52:1888-1896. [PMID: 38258480 DOI: 10.1177/03635465231192987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND The optimal timing of anterior cruciate ligament (ACL) reconstruction (ACLR) remains a controversial topic. Previous reviews have demonstrated that there are no differences between early and delayed ACLR; however, these studies have been limited by heterogeneous definitions of acute ACL injury. PURPOSE To evaluate postoperative patient functional outcomes and risk for arthrofibrosis after acute arthroscopic ACLR performed ≤10 days after injury. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using multiple medical databases. Inclusion criteria were studies that evaluated postoperative range of motion outcomes for patients undergoing ACLR ≤10 days after initial ACL injury. For included comparative studies comparing patient groups undergoing ACLR ≤10 days and patients undergoing "delayed" ACLR after ≥3 weeks of initial injury, quantitative analysis was performed to assess for differences in postoperative arthrofibrosis, reoperation rates, and patient-reported outcomes between groups. DerSimonian-Laird binary random-effects models were constructed to quantitatively describe the association between the ACLR time period and patient outcomes by generating effect estimates in the form of odds ratios with 95% CIs. Qualitative analysis was performed to describe variably reported patient outcomes and the risk of arthrofibrosis after ACLR for noncomparative studies. RESULTS Screening yielded 6 full-text articles with 448 patients who underwent ACLR (296 ACLR <10 days, 152 ACLR >3 weeks), with a pooled mean age of 28.1 years. For studies amenable to quantitative analysis, there were no significant differences between ACLR performed ≤10 days and ACLR performed at the 3-week point or after in terms of postoperative stiffness (3 studies; odds ratio, 1.27; P = .508), Tegner scores (2 studies; mean difference, -0.056; P = .155), or reoperation for stiffness (3 studies; odds ratio, 0.869; P = .462). The overall incidence of postoperative arthrofibrosis after 12 months of follow-up was 11 of 296 (3.7%) for ACLRs performed ≤10 days versus 6 of 152 (3.9%) for those performed at the 3-week point or after. CONCLUSION ACLR performed ≤10 days after the inciting injury does not increase the risk of postoperative arthrofibrosis and demonstrates similar patient-reported outcomes compared with ACLR performed at the 3-week point or after.
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Affiliation(s)
- Zachary S Aman
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Olivia K Blaber
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emily R McDermott
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Mikalyn T DeFoor
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Nicholas N DePhillipo
- Department of Orthopedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Travis J Dekker
- Department of Orthopaedic Surgery, 10th Medical Group, US Air Force Academy, Colorado Springs, Colorado, USA
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Saithna A, Helito CP, Bin Abd Razak HR, Cristiani R. Secondary restraints in ACL reconstruction: State-of-the-art. J ISAKOS 2024:S2059-7754(24)00088-9. [PMID: 38734309 DOI: 10.1016/j.jisako.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 03/07/2024] [Accepted: 05/04/2024] [Indexed: 05/13/2024]
Abstract
At-risk patients continue to experience a high likelihood of graft rupture after anterior cruciate ligament (ACL) reconstruction (ACLR). This narrative review seeks to provide the reader with an evidence-based synopsis of state-of-the-art concepts related to secondary restraint lesions, and how addressing them surgically might result in improved outcomes of ACLR.
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Affiliation(s)
- Adnan Saithna
- Department of Orthopedic Surgery, University of Arizona, Tucson, AZ, 85724, USA; AZBSC Orthopedics, 7649 E Pinnacle Peak Rd, Scottsdale, AZ, 85255, USA.
| | - Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 333 - Cerqueira Cesar, São Paulo, SP, CEP: 05403-010, Brazil; Hospital Sírio Libanês, Rua Dona Adma Jafet, 91 - Bela Vista, São Paulo, SP, CEP 01308-050, Brazil
| | - Hamid Rahmatullah Bin Abd Razak
- Total Orthopaedic Care & Surgery, Novena Medical Centre, 10 Sinaran Drive, 307506 Singapore; SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme, 20 College Road, Academia Level 4, 169865, Singapore
| | - Riccardo Cristiani
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden; Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486, Stockholm, Sweden
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Fischer W. [Meniscus update]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:254-260. [PMID: 38519603 DOI: 10.1007/s00117-024-01294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
Meniscus tears are classified as horizontal, longitudinal, radial, and complex tears. Flap tears are a specific form in which a portion of the meniscus is displaced from a horizontal or longitudinal tear. The question of whether it is possible to preserve the meniscus by meniscus repair is of crucial therapeutic importance. It is therefore important to specify not only the configuration of the tear but also its extent and location as precisely as possible. Cooper's zonal classification should also be used for this purpose. Lesions of the meniscus roots are of high clinical relevance. On the posterior horn of the medial meniscus, root lesions are usually degenerative; on the posterior horn of the lateral meniscus, they are often traumatic. It is important to familiarize oneself with the normal appearance and anatomical location of the meniscal roots. Ramp lesions have received particular attention in recent years, especially in patients with anterior cruciate ligament tears. Therefore, particularly the integrity of the attachment of the posterior horn of the medial meniscus to the tibial plateau must be analyzed. If the meniscotibial ligament tears along its course or at the insertion to the meniscus or if it avulses with a meniscus fragment, this is a ramp lesion.
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Affiliation(s)
- Wolfgang Fischer
- MRT Hessingpark-Clinic, Radiologie Augsburg-Friedberg, Hessingstr. 17, 86199, Augsburg, Deutschland.
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Deichsel A, Miets H, Peez C, Raschke MJ, Klimek M, Glasbrenner J, Herbst E, Kittl C. The Effect of Varying Sizes of Ramp Lesions in the ACL-Deficient and Reconstructed Knee: A Biomechanical Robotic Investigation. Am J Sports Med 2024; 52:928-935. [PMID: 38343294 DOI: 10.1177/03635465231223686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND Conflicting evidence has been reported regarding the biomechanical relevance of ramp lesions (RLs) on knee kinematics. Furthermore, the influence of the defect size of the RLs on anterior tibial translation (ATT) and external rotation (ER) is currently unknown. PURPOSE To evaluate the influence of RL defect size on knee kinematics in anterior cruciate ligament (ACL) deficiency and after simulated ACL reconstruction (sACLR). STUDY DESIGN Controlled laboratory study. METHODS Eight cadaveric knee specimens were tested in a 6 degrees of freedom robotic test setup. Force-controlled clinical laxity tests were performed with 200 N of axial compression in 0°, 30°, 60°, and 90° of flexion: 5 N·m internal rotation (IR)/ER torque, 134 N ATT force, and an anteromedial drawer test consisting of 134 N ATT force under 5 N·m ER torque. After determining the native knee kinematics, the ACL was cut at the tibial insertion, followed by a transosseous refixation to simulate a surgical repair or reconstruction (simulated ACL reconstruction; sACLR). An RL was sequentially created with a length of 1, 2, and 3 cm. Each state of the RL was evaluated in the ACL-deficient state and after sACLR. RESULTS In the ACL-deficient state, only an RL of 3 cm length resulted in a significant increase of ATT in 30° of flexion (mean difference 0.73 mm; 95% CI, 0.36-1.1 mm). After sACLR, an RL had no significant effect. When looking at ER, an RL significantly increased ER in full extension in the ACL-deficient state in 2 cm (mean difference 0.9°; 95% CI, 0.08°-1.74°) and 3 cm length (mean difference 1.9°; 95% CI, 0.57-3.25). Furthermore, a 3-cm RL significantly increased IR in 0° of flexion in the ACL-deficient state (mean difference 1.9°; 95% CI, 0.2°-3.6°). No effect of ramp lesions on rotation was found after sACLR. CONCLUSION RLs result in a small increase in ATT, ER, and IR in ACL-deficient knees at early flexion angles, but not after sACLR. CLINICAL RELEVANCE Small RLs did not change time-zero knee kinematics and may, therefore, be left untreated, especially when the ACL is reconstructed.
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Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Henrike Miets
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Matthias Klimek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
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11
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Allende F, García JR, Chahla J. Editorial Commentary: A Gap-Based Subclassification of Ramp Lesions Has the Potential to Enhance Treatment Precision and Patient Outcomes in Anterior Cruciate Ligament-Deficient Knees Subtitle: Customizing Solutions for Anterior Cruciate Ligament-Deficient Knees. Arthroscopy 2024; 40:887-889. [PMID: 38219103 DOI: 10.1016/j.arthro.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 01/15/2024]
Abstract
Our evolving understanding of ramp lesions has significantly affected the field of anterior cruciate ligament injury and meniscal repair. Although these lesions have been linked consistently to increased anterior and rotational instability in anterior cruciate ligament-deficient knees, there remains a contentious debate regarding their optimal treatment. The current literature is divided, as some advocate for surgical repair of only arthroscopically unstable lesions. Others point to a substantial risk of complications, noting a 28.6% incidence in untreated stable lesions, and thus advocate for surgical repair of all lesions. Through the use of magnetic resonance imaging scans of flexed knees, a novel subclassification of ramp lesions based on gap distance at the tear site shows a correlation with posterior capsular displacement, anterior laxity, lesion size, and joint effusion. This nuanced classification offers new insights and promises to refine treatment decisions, potentially minimizing unnecessary surgeries and improving patient outcomes.
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Affiliation(s)
- Felicitas Allende
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - José Rafael García
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.; Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
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12
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Benson EM, Wood A, Harris C, Smith P, Xerogeanes J, Casp A, Momaya A. Anchor-Based Meniscal Ramp Repair. Arthrosc Tech 2024; 13:102846. [PMID: 38435252 PMCID: PMC10907898 DOI: 10.1016/j.eats.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/21/2023] [Indexed: 03/05/2024] Open
Abstract
Ramp lesions of the medial meniscus are underdiagnosed because of difficulty in visualizing via magnetic resonance imaging and during arthroscopy. They most often occur simultaneously with anterior cruciate ligament (ACL) injury but may also be associated with posterior plateau contusions, steeper medial tibial plateau slope, and excess varus alignment. Upwards of 24% of ACL reconstructions have concomitant ramp lesions. Failure to repair the ramp lesion is associated with increased rotational laxity, tibial translocation, persistent pivot shift, and poorer outcomes after ACL reconstruction. The purpose of this article is to describe an all-suture anchor-based repair of a meniscal ramp lesion, which confers several advantages over traditional repair techniques.
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Affiliation(s)
| | - Audria Wood
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Chandler Harris
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patrick Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia; Columbia Orthopaedic Group, Columbia, Missouri
| | - John Xerogeanes
- Department of Orthopaedic Surgery, Division of Sports Medicine, Emory University, Atlanta, Georgia, U.S.A
| | - Aaron Casp
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amit Momaya
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, Alabama
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13
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Farinelli L, Meena A, Sonnery-Cottet B, Vieira TD, Pioger C, Gigante A, Abermann E, Hoser C, Fink C. Increased Intra-Articular Internal Tibial Rotation Is Associated With Unstable Medial Meniscus Ramp Lesions in ACL-Injured Athletes: An MRI Matched-Pair Comparative Study. Arthrosc Sports Med Rehabil 2024; 6:100839. [PMID: 38187951 PMCID: PMC10768481 DOI: 10.1016/j.asmr.2023.100839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 11/03/2023] [Indexed: 01/09/2024] Open
Abstract
Purpose To analyze internal tibial rotation through magnetic resonance imaging (MRI) of patients with anterior cruciate ligament (ACL) injuries with and without an unstable medial meniscal ramp lesion (MMRL). Methods Retrospective analysis of prospectively data was performed to include all consecutive patients who underwent primary ACL reconstruction (ACLR) between January 2022 and June 2022. Two groups, ACLR + unstable MMRL and ACLR without MMRL, were constituted. Propensity score matching analysis was used to limit selection bias. The angle between surgical epicondylar axes (SEAs) and the tangent line of the posterior tibial condyles (PTCs) was measured to analyze the rotational alignment between distal femur and proximal tibia. MMRLs were defined unstable if they were ≥1 cm, if the lesions extend beyond the lower pole of the femoral condyle, and/or if there was displacement into the medial compartment by anterior probing. Results Twenty-eight propensity-matched pairs were included. The ACLR + unstable MMRL presented a significantly greater internal rotation of the tibia compared to ACLR without MMRL (P < .001). An internal tibial rotation was associated with unstable ramp lesions in ACL-injured patients (odds ratio [OR], 0.36; 95% CI, 0.25-0.41; P < .0001). If SEA-PTC was 0°, the sensitivity and specificity of the SEA-PTC angle to detect unstable MMRL were respectively 100% (95% CI, 85%-100%) and 18% (95% CI, 8%-36%). Otherwise, if SEA-PTC angle was -10°, the sensitivity and specificity of the SEA-PTC angle to detect unstable MMRL were respectively 43% (95% CI, 27%-61%) and 96% (95% CI, 81%-100%). Bone edema of the posterior medial tibial plateau was significantly associated with unstable ramp lesions (OR, 1.58; 95% CI, 1.21-2.06; P = .029). Conclusions Unstable MMRL concomitant to an ACL rupture was associated with an increased tibial internal rotation. Level of Evidence Level III, retrospective comparative trial.
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Affiliation(s)
- Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Amit Meena
- Gelenkpunkt–Sports and Joint Surgery, Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA medical Centre of Excellence, Hôpital Mermoz, Groupe Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA medical Centre of Excellence, Hôpital Mermoz, Groupe Ramsay, Lyon, France
| | - Charles Pioger
- Department of Orthopaedic Surgery, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Elisabeth Abermann
- Gelenkpunkt–Sports and Joint Surgery, Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Christian Hoser
- Gelenkpunkt–Sports and Joint Surgery, Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Christian Fink
- Gelenkpunkt–Sports and Joint Surgery, Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
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14
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Familiari F, Tollefson LV, Izzo A, Mercurio M, LaPrade RF, Di Vico G. A High-Grade Lachman's Exam Predicts a Ramp Tear of the Medial Meniscus in Patients with Anterior Cruciate Ligament Tear: A Prospective Clinical and Radiological Evaluation. J Clin Med 2024; 13:683. [PMID: 38337378 PMCID: PMC10856171 DOI: 10.3390/jcm13030683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Medial meniscus ramp tears are present in 22.9-40.8% of anterior cruciate ligament tears. The diagnosis of ramp tears is difficult on MRI, with sensitivity reported around 48%, which has recently emphasized the importance of proper arthroscopic probing for ramp tears. Methods: A prospective evaluation was performed on patients undergoing a single bundle ACL reconstruction to assess patient demographics, posterior tibial slope, posterior cruciate ligament angle, Lachman's exam, and rotational instability to determine secondary findings associated with medial meniscal ramp tears. Results: A total of 96 patients underwent ACL reconstruction, of these, 63 patients had an isolated ACL tear, and 33 patients had an ACL tear with a concomitant medial meniscus ramp tear. A high-grade Lachman's exam and male sex were associated with medial meniscus ramp tears. There were no differences in posterior tibial slope, posterior cruciate ligament angle, or rotational instability between groups. Conclusions: This study found that a high-grade Lachman's exam and male sex were significantly associated with patients with an ACL tear with a concomitant medial meniscus ramp tear. These findings suggest that an ACL tear with concomitant medial meniscus ramp tear may be better diagnosed based upon the clinical evaluation rather than other secondary radiological findings.
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Affiliation(s)
- Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletal Health@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Luke V. Tollefson
- Twin Cities Orthopedics, Edina, MN 55435, USA; (L.V.T.); (A.I.); (R.F.L.)
| | - Antonio Izzo
- Twin Cities Orthopedics, Edina, MN 55435, USA; (L.V.T.); (A.I.); (R.F.L.)
- Department of Public Health, Trauma and Orthopaedics, University Federico II, 80138 Napoli, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, Magna Graecia University, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletal Health@UMG, Magna Graecia University, 88100 Catanzaro, Italy
| | - Robert F. LaPrade
- Twin Cities Orthopedics, Edina, MN 55435, USA; (L.V.T.); (A.I.); (R.F.L.)
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15
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Severyns M, Zot F, Harika-Germaneau G, Germaneau A, Herpe G, Naudin M, Valle V, Danion J, Vendeuvre T. Extrusion and meniscal mobility evaluation in case of ramp lesion injury: a biomechanical feasibility study by 7T magnetic resonance imaging and digital volume correlation. Front Bioeng Biotechnol 2024; 11:1289290. [PMID: 38249805 PMCID: PMC10796713 DOI: 10.3389/fbioe.2023.1289290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction: The existing body of literature on the biomechanical implications of ramp lesions is limited, leaving a significant gap in our understanding of how these lesions impact joint kinematics and loading in the medial compartment. This cadaveric biomechanical study aims to address this gap by employing an innovative Digital Volume Correlation (DVC) method, utilizing 7 Tesla Magnetic Resonance Imaging (MRI) images under various loading conditions. The primary objective is to conduct a comprehensive comparison of medial meniscal mobility between native knees and knees affected by grade 4 ramp lesions. By focusing on the intricate dynamics of meniscal mobility and extrusion, this work seeks to contribute valuable insights into the biomechanical consequences of medial meniscus ramp lesions. Materials and methods: An initial set of 7T MRI imaging sessions was conducted on two intact native knees, applying load values up to 1500N. Subsequently, a second series of images was captured on these identical knees, with the same loads applied, following the creation through arthroscopy of medial meniscus ramp lesions. The application of DVC enabled the precise determination of the three components of displacement and spatial variations in the medial menisci, both with and without ramp lesions. Results: The measured directional displacements between native knees and injured knees indicate that, following the application of axial compression load, menisci exhibit increased extrusion and posterior mobility as observed through DVC. Discussion: Injuries associated with Subtype 4 medial meniscus ramp lesions appear to elevate meniscal extrusion and posterior mobility during axial compression in the anterior cruciate ligament of intact knees. Following these preliminary results, we plan to expand our experimental approach to encompass individuals undergoing weight-bearing MRI. This expansion aims to identify meniscocapsular and/or meniscotibial insufficiency or rupture in patients, enabling us to proactively reduce the risk of osteoarthritic progression.
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Affiliation(s)
- M. Severyns
- Institut Pprime UPR 3346, Centre National de Recherche Scientifique–Université de Poitiers–ISAE-ENSMA, Poitiers, France
- Department of Orthopaedic Surgery and Traumatology, Clinique Porte Océane, Les Sables d’Olonne, France
| | - F. Zot
- Institut Pprime UPR 3346, Centre National de Recherche Scientifique–Université de Poitiers–ISAE-ENSMA, Poitiers, France
| | - G. Harika-Germaneau
- Unité de Recherche Clinique Pierre Deniker, CH Henri Laborit, Centre de Recherches sur la Cognition et l’Apprentissage UMR 7295, Centre National de Recherche Scientifique–Université de Poitiers, Poitiers, France
| | - A. Germaneau
- Institut Pprime UPR 3346, Centre National de Recherche Scientifique–Université de Poitiers–ISAE-ENSMA, Poitiers, France
| | - G. Herpe
- CHU de Poitiers, Department of Radiology, LabCom I3M Centre National de Recherche Scientifique–Siemens Healthineers, LMA, UMRCNRS 7348, Université de Poitiers, Poitiers, France
| | - M. Naudin
- CHU de Poitiers, Department of Radiology, LabCom I3M Centre National de Recherche Scientifique–Siemens Healthineers, LMA, UMRCNRS 7348, Université de Poitiers, Poitiers, France
| | - V. Valle
- Institut Pprime UPR 3346, Centre National de Recherche Scientifique–Université de Poitiers–ISAE-ENSMA, Poitiers, France
| | - J. Danion
- CHU de Poitiers, ABS Lab, Poitiers, France
| | - T. Vendeuvre
- Institut Pprime UPR 3346, Centre National de Recherche Scientifique–Université de Poitiers–ISAE-ENSMA, Poitiers, France
- CHU de Poitiers, Department of Orthopaedic Surgery and Traumatology, Poitiers, France
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16
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Green JS, Moran J, Marcel A, Joo PY, McLaughlin WM, Manzi JE, Yalcin S, Wang A, Porrino J, Jimenez AE, Medvecky MJ, Katz LD. Posteromedial tibial plateau bone bruises are associated with medial meniscal ramp lesions in patients with concomitant anterior cruciate ligament ruptures: a systematic review & meta-analysis. PHYSICIAN SPORTSMED 2023; 51:531-538. [PMID: 35915996 DOI: 10.1080/00913847.2022.2108350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To determine if posteromedial tibial plateau (PMTP) bone bruising on pre-operative MRI is significantly associated with a ramp lesion identified during arthroscopy in patients with concomitant ACL ruptures. METHODS PubMed, CINAHL, Scopus, Web of Sciences, EMBASE, and Cochrane Library were searched systematically for studies that investigated the association between PMTP bone bruises on preoperative MRI and ramp lesions confirmed during arthroscopy. Eight studies met inclusion criteria. The Methodological Index for Nonrandomized Studies (MINORS) checklist was used to assess quality. A meta-analysis was performed to analyze odds of a ramp lesion after PMTP bone bruising identified on magnetic resonance imaging (MRI). Publication bias was assessed by funnel plot and Egger's linear regression test. RESULTS There are 2.05 greater odds of medial meniscal ramp lesions in patients with an ACL rupture when PMTP bone bruising is found on preoperative MRI (95% CI, 1.29-3.25; p = 0.002). Heterogeneity of the pooled studies may be substantial (I2 = 65%; p = 0.006). Funnel plot analysis and Egger's linear regression test (p > 0.5) determined no publication bias among the studies included in the meta-analysis. CONCLUSION Patients with acute ACL injuries and PMTP bone bruising on MRI have 2.05 times greater odds of a concomitant medial meniscal ramp lesion than those without this bone bruise pattern.
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Affiliation(s)
- Joshua S Green
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Jay Moran
- Yale School of Medicine, New Haven, CT, USA
| | - Aaron Marcel
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | | | - William M McLaughlin
- Department of Rehabilitation & Orthopaedics, Yale School of Medicine, New Haven, CT, USA
| | | | - Sercan Yalcin
- Department of Rehabilitation & Orthopaedics, Yale School of Medicine, New Haven, CT, USA
| | - Annie Wang
- Department of Radiology, Musculoskeletal Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Jack Porrino
- Department of Radiology, Musculoskeletal Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Andrew E Jimenez
- Department of Rehabilitation & Orthopaedics, Yale School of Medicine, New Haven, CT, USA
| | - Michael J Medvecky
- Department of Rehabilitation & Orthopaedics, Yale School of Medicine, New Haven, CT, USA
| | - Lee D Katz
- Department of Radiology, Musculoskeletal Imaging, Yale School of Medicine, New Haven, CT, USA
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Kraeutler MJ, McCulloch PC, Sherman SL, Vidal AF. The Principles of Knee Joint Preservation: Operative Treatment Strategies. J Bone Joint Surg Am 2023; 105:1638-1646. [PMID: 37616413 DOI: 10.2106/jbjs.23.00212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
➤ Joint alignment, meniscal status, and ligament stability are codependent factors involved in knee joint preservation, and any injury or imbalance can impact the knee articular cartilage status and can result in adverse clinical outcomes.➤ Cartilage preservation procedures in the knee will not result in optimal outcomes if there is joint malalignment, meniscal deficiency, or ligamentous instability.➤ Lower-extremity varus or valgus malalignment is a risk factor for the failure of an anterior cruciate ligament (ACL) reconstruction. It represents an indication for a high tibial osteotomy or distal femoral osteotomy in the setting of failed ACL reconstruction, and may even be considered in patients who have an initial ACL injury and severe malalignment.➤ An elevated posterior tibial slope increases the risk of failure of ACL reconstruction, whereas a decreased posterior tibial slope increases the risk of failure of posterior cruciate ligament reconstruction.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Patrick C McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Seth L Sherman
- Department of Orthopedic Surgery, Stanford University, Redwood City, California
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18
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Zhang L, Yang R, Mao Y, Fu W. A Systematic Review and Meta-analysis of Risk Factors for an Infection After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2023; 11:23259671231200822. [PMID: 37846316 PMCID: PMC10576935 DOI: 10.1177/23259671231200822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 10/18/2023] Open
Abstract
Background Identifying risk factors for an infection after anterior cruciate ligament reconstruction (ACLR) and following targeted preventive strategies can effectively reduce this potentially serious complication. Purpose To perform a systematic review and meta-analysis to identify the risk factors for an infection after ACLR. Study Design Systematic review; Level of evidence, 4. Methods The PubMed, Embase, and Web of Science databases were searched from inception to September 1, 2022, for prospective and retrospective studies investigating risk factors for any type of infection after ACLR. Odds ratios (ORs) or mean differences were calculated for potential risk factors if ≥2 studies assessed the same risk factor. A qualitative analysis of variables was performed if a meta-analysis could not be conducted. Results A total of 17 studies with 141,991 patients were included in this review. The overall pooled infection rate was 0.86% (range, 0.24%-5.50%). There were 20 risk factors identified for analysis. Of these, 7 variables independently increased the odds of an infection after ACLR: (1) male sex (OR, 1.90 [95% CI, 1.33-2.73]), (2) diabetes (OR, 2.69 [95% CI, 1.66-4.35]), (3) hamstring tendon autograft (OR, 2.51 [95% CI, 2.03-3.10]), (4) revision ACLR (OR, 2.31 [95% CI, 1.22-4.37]), (5) professional athlete status (OR, 6.21 [95% CI, 1.03-37.38]), (6) lateral tenodesis (OR, 3.45 [95% CI, 1.63-7.28]), and (7) corticosteroid use (OR, 7.83 [95% CI, 3.68-16.63]). No significant associations were found between postoperative infections and age, body mass index, smoking, meniscal repair, or outpatient surgery. Conclusion This review revealed that an increased risk of infections after ACLR was associated with male sex, diabetes, hamstring tendon autograft, revision surgery, professional athlete status, lateral tenodesis, and steroid use. Knowledge of the risk factors associated with an infection after ACLR may facilitate the identification of high-risk cases and the implementation of preventive measures to mitigate the serious consequences of this complication.
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Affiliation(s)
- Lei Zhang
- Orthopedics Research Institute, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Runze Yang
- Orthopedics Research Institute, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yunhe Mao
- Orthopedics Research Institute, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Orthopedics Research Institute, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Dansuk E, Kemah B, Polat G, Erdil ME. The effect of anterior cruciate ligament reconstruction and RAMP lesion repair on psychological status. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2873-2880. [PMID: 36877408 DOI: 10.1007/s00590-023-03510-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/26/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND There are few studies examining anterior cruciate ligament reconstruction (ACLR) and RAMP lesion repair. However, no studies have investigated the level of functional performance and psychological state after ACLR and all-inside RAMP lesion repair. HYPOTHESIS/PURPOSE The aim of this study is to determine the effect of ACLR and RAMP lesion repair on psychological status. ACLR and meniscal RAMP lesion repair were hypothesized to be associated with better psychological outcomes. STUDY DESIGN This is a cohort study. METHODS Patients who underwent ACLR with semitendinosus and gracilis autografts by a single surgeon were determined retrospectively. Fifteen patients who underwent ACLR and all-inside meniscus RAMP lesion repair (ACLR-RR) and 15 patients who underwent isolated ACLR were compared. Patients were evaluated by a physiotherapist at least 9 months after surgery. The primary outcome measure was anterior cruciate ligament-return to sports after injury (ACL-RSI), and the psychological status of the patients was examined. Secondary outcomes were visual analog scale (VAS), Tegner activity score, Lysholm knee score, single hop tests, and limb symmetry index (LSI). While pain intensity at rest and during movement was evaluated with VAS, functional performance level was evaluated with the Tegner activity score, the Lysholm knee score, single hop tests, and limb symmetry index (LSI). RESULTS A significant difference was found in the ACL-RSI values in the ACLR-RR group compared to the isolated ACLR group (p = 0.02). The results of the groups in VAS scores at rest and during movement, Tegner activity levels, and Lysholm knee scores, in the intact and operated leg single hop tests (single leg hop, cross hop, triple hop, and six-meter hop test), and the LSI values in the single leg hop tests showed no significant difference. CONCLUSIONS This study revealed different psychological outcomes and similar functional levels for ACLR and all-inside meniscus RAMP repair compared with isolated ACLR. It was observed that the psychological status of patients with RAMP lesions should also be evaluated.
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Affiliation(s)
- Emre Dansuk
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey.
| | - Bahattin Kemah
- Department of Orthopaedics and Traumatology, S.B University Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Gökhan Polat
- Department of Orthopaedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Emin Erdil
- Department of Orthopaedics and Traumatology, Acibadem Maslak Hospital, Acibadem University, Istanbul, Turkey
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Migliorini F, Pilone M, Bell A, Celik M, Konrads C, Maffulli N. Outside-in repair technique is effective in traumatic tears of the meniscus in active adults: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:4257-4264. [PMID: 37314454 PMCID: PMC10471662 DOI: 10.1007/s00167-023-07475-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Meniscal injuries are common. Outside-in meniscal repair is one of the techniques advocated for the management of traumatic meniscal tears. This systematic review investigated the outcomes of the outside-in repair technique for the management of traumatic tears of the menisci. The outcomes of interest were to investigate whether PROMs improved and to evaluate the rate of complications. METHODS Following the 2020 PRISMA statement, in May 2023, PubMed, Web of Science, Google Scholar, and Embase were accessed with no time constraints. All the clinical investigations which reported data on meniscal repair using the outside-in technique were considered for inclusion. Only studies which reported data on acute traumatic meniscal tears in adults were considered. Only studies which reported a minimum of 24 months of follow-up were eligible. RESULTS Data from 458 patients were extracted. 34% (155 of 458) were women. 65% (297 of 458) of tears involved the medial meniscus. The mean operative time was 52.9 ± 13.6 min. Patients returned to their normal activities at 4.8 ± 0.8 months. At a mean of 67-month follow-up, all PROMs of interest improved: Tegner scale (P = 0.003), Lysholm score (P < 0.0001), International Knee Documentation Committee (P < 0.0001). 5.9% (27 of 458) of repairs were considered failures. Four of 186 (2.2%) patients experienced a re-injury, and 5 of 458 (1.1%) patients required re-operation. CONCLUSION Meniscal repair using the outside-in technique can be effectively performed to improve the quality of life and the activity level of patients with acute meniscal tears. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
- Department of Orthopaedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100 Bolzano, Italy
| | - Marco Pilone
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany
| | - Michael Celik
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Christian Konrads
- Department of Orthopaedics and Traumatology, Helios Hanseatic Hospital Stralsund, Stralsund, Germany
- Medical Faculty, University of Tübingen, 72076 Tübingen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, ST4 7QB Stoke On Trent, England
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, E1 4DG London, England
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LaPrade CM, Homan MD, Moran J, Kennedy NI, LaPrade RF. Concurrent Repair of Medial Meniscal Ramp Lesions and Lateral Meniscus Root Tears in Patients Undergoing Anterior Cruciate Ligament Reconstruction: The "New Terrible Triad". Arthrosc Tech 2023; 12:e1565-e1578. [PMID: 37780663 PMCID: PMC10533866 DOI: 10.1016/j.eats.2023.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/25/2023] [Indexed: 10/03/2023] Open
Abstract
Recent studies have suggested that up to 8% of patients with anterior cruciate ligament (ACL) tears can present with a combined medial meniscal ramp lesion (MMRL) and lateral meniscus root tear (LMRT). MMRLs and LMRTs often are missed preoperatively and can increase the risk of ACL graft failure if left untreated. Given the potential synergistic biomechanical consequences and challenging repair techniques used for treatment, our group commonly refers to this presentation (MMRL-LMRT-ACL) as the "new terrible triad" of ACL pathology. This Technical Note aims to describe a systematic approach for arthroscopic assessment and our preferred inside-out and transtibial pull-out repair techniques to efficiently diagnose and treat a combined MMRL and LMRT at the time of ACL reconstruction surgery.
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Affiliation(s)
- Christopher M. LaPrade
- Stanford Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | | | - Jay Moran
- Yale School of Medicine, New Haven, Connecticut, U.S.A
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Kim YS, Koo S, Kim JH, Tae J, Wang JH, Ahn JH, Jang KM, Jeon J, Lee DK. Greater Knee Rotatory Instability After Posterior Meniscocapsular Injury Versus Anterolateral Ligament Injury: A Proposed Mechanism of High-Grade Pivot Shift. Orthop J Sports Med 2023; 11:23259671231188712. [PMID: 37693803 PMCID: PMC10486219 DOI: 10.1177/23259671231188712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 09/12/2023] Open
Abstract
Background For anterolateral rotatory instability as a result of secondary soft tissue injuries in anterior cruciate ligament (ACL)-deficient knees, there is increasing interest in secondary stabilizers to prevent internal rotation (IR) of the tibia. Purpose To determine which secondary stabilizer is more important in anterolateral rotatory instability in ACL-deficient knees. Study Design Controlled laboratory study. Methods The lower extremities of 10 fresh-frozen cadavers (20 extremities) without anterior-posterior or rotational instability were included. Matched-pair randomization was performed, with each side per specimen assigned to 1 of 2 groups. In group 1, the ACL was sectioned, followed by the anterolateral ligament (ALL); in group 2, the ACL was sectioned, followed by sequential sectioning of the posterolateral meniscocapsular complex (PLMCC) and posteromedial meniscocapsular complex (PMMCC). The primary outcome was the change in relative tibial IR during a simulated pivot-shift test with 5 N·m of IR torque and 8.9 N of valgus force. The secondary outcomes were the International Knee Documentation Committee grade in the pivot-shift test and the incidence of the grade 3 pivot shift. Results In group 1, compared with baseline, the change in relative tibial IR at 0° of knee flexion was 1.4° (95% CI, -0.1° to 2.9°; P = .052) after ALL release. In group 2, it was 2.5° (95% CI, 0.4° to 4.8°; P = .007) after PLMCC release and 4.1° (95% CI, 0.5° to 7.8°; P = .017) after combined PLMCC and PMMCC release. Combined PLMCC and PMMCC release resulted in greater change of tibial IR with statistical significance at 0°, 15°, and 30° of knee flexion (P = .008, .057, and .004, respectively) compared with ALL release. The incidence of grade 3 pivot shifts was 10% in group 1 and 90% in group 2. Conclusion Posterior meniscocapsular laxity caused an increase in relative tibial IR as much as ALL injury in ACL-deficient knees in our simulated laboratory test, and greater anterolateral rotatory instability occurred with posterior meniscocapsular injury compared with ALL injury. Clinical Relevance Repair of the injured posterior meniscocapsular complex may be an important treatment option for reducing anterolateral rotatory instability in the ACL-deficient knee.
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Affiliation(s)
- Yi-Suk Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungbum Koo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Kyunghee University Hospital at Gangdong, Kyunghee University School of Medicine, Seoul, Republic of Korea
| | - Jungyeun Tae
- Konyang University School of Medicine, Daejeon, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Hwan Ahn
- Department of Orthopaedic Surgery, Saeum Hospital, Seoul, Republic of Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jongmin Jeon
- Department of Orthopedic Surgery, Changwon Samsung Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Do Kyung Lee
- Department of Orthopedic Surgery, Changwon Samsung Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
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Pires D, Monteiro L, Rocha de Faria JL, Albuquerque RSPE, Astur D, Pádua VBCD, Salim R, LaPrade RF. Diagnosis by Manual Maneuver of Medial Meniscus Ramp Lesions. Arthrosc Tech 2023; 12:e959-e964. [PMID: 37424638 PMCID: PMC10323914 DOI: 10.1016/j.eats.2023.02.033] [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: 11/02/2022] [Revised: 01/22/2023] [Accepted: 02/14/2023] [Indexed: 07/11/2023] Open
Abstract
The intra-articular injury most often associated with a chronic anterior cruciate ligament tear involves the posterior horn of the medial meniscus. A specific type of medial meniscal injury, called a ramp lesion, has received greater attention for identification and treatment because of its considerable incidence and diagnostic difficulty. Based on their location, these lesions may be arthroscopically "hidden" during traditional anterior visualization. The purpose of the present Technical Note is to describe the Recife maneuver. This maneuver diagnoses injuries to the posterior horn of the medial meniscus using additional arthroscopic management through a standard portal. The Recife maneuver is performed with the patient in the supine position. A 30° arthroscope is inserted through the anterolateral portal, and the posteromedial compartment is accessed according to the transnotch view (modified Gillquist view). In the proposed maneuver, with the knee in 30° of flexion, a valgus stress with internal rotation is performed, followed by palpation of the popliteal region and digital pressure on the joint interline. This maneuver allows a greater visualization of the posterior compartment, allowing the diagnostic evaluation of the integrity between the meniscus and the capsule, in a safer way, being able to identify ramp tears without the need to create a posteromedial portal. We recommend that the addition of the diagnostic visualization step of the posteromedial compartment as described by the Recife maneuver be performed to assess the meniscal status in routine anterior cruciate ligament reconstruction.
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Affiliation(s)
- Diego Pires
- Integral Medicine Institute Prof Fernado Figueira Recife, PE, Brazil
| | | | - José Leonardo Rocha de Faria
- Knee Surgery Center of the National Institute of Traumatology and Orthopedics of Brazil, Rio de Janeiro, RJ, Brazil
- School of Medicine from University of São Paulo, USP Riberão Preto, SP, Brazil
| | | | | | | | - Rodrigo Salim
- School of Medicine from University of São Paulo, USP Riberão Preto, SP, Brazil
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Hollnagel KF, Pennock AT, Bomar JD, Chambers HG, Edmonds EW. Meniscal Ramp Lesions in Adolescent Patients Undergoing Primary Anterior Cruciate Ligament Reconstruction: Significance of Imaging and Arthroscopic Findings. Am J Sports Med 2023; 51:1506-1512. [PMID: 36847270 DOI: 10.1177/03635465231154600] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Meniscal ramp lesions are associated with anterior cruciate ligament (ACL) injuries and may affect knee stability when left untreated. The diagnostic accuracy of magnetic resonance imaging (MRI) to identify this meniscocapsular injury of the posterior horn of the medial meniscus remains poor, and the arthroscopic findings require vigilance. PURPOSE To determine the concordance of arthroscopic and MRI findings to better identify the presence of a ramp lesion in children and adolescent patients undergoing primary ACL reconstruction. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Patients aged <19 years who underwent primary ACL reconstruction at a single institution between 2020 and 2021 were included. Two cohorts were developed by the presence of a ramp lesion arthroscopically. Basic patient descriptive data, preoperative imaging (radiologist assessment and independent reviewer assessment), and concomitant arthroscopic findings at the time of ACL reconstruction were recorded. RESULTS An overall 201 adolescents met criteria with a mean age of 15.7 years (range, 6.9-18.2) at the time of injury. A ramp lesion was identified in 14% of patients (28 children). No differences were detected between cohorts with regard to age, sex, body mass index, weeks from injury to MRI, or weeks from injury to surgery (P > .15). The primary predictor of an intraoperative ramp lesion was the presence of medial femoral condylar striations, with an adjusted odds ratio of 722.2 (95% CI, 59.5-8768.2; P < .001); the presence of a ramp lesion on MRI had an adjusted odds ratio of 11.1 (95% CI, 2.2-54.8; P = .003). Patients with neither a ramp lesion on MRI nor medial femoral condylar striations had a 2% rate (2/131) of ramp lesion; those with either of the significant risk factors had a 24% rate (14/54). All patients with both risk factors (100%; n = 12) had a ramp lesion noted on intraoperative examination. CONCLUSION The concordance of medial femoral condylar chondromalacia, particularly striations, noted during arthroscopy and posteromedial tibial marrow edema on MRI with or without direct evidence of posterior meniscocapsular pathology should increase suspicion for the presence of a ramp lesion in adolescents undergoing ACL reconstruction.
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Affiliation(s)
| | | | - James D Bomar
- Rady Children's Hospital, San Diego, California, USA
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25
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Over One-Third of Patients With Multiligament Knee Injuries and an Intact Anterior Cruciate Ligament Demonstrate Medial Meniscal Ramp Lesions on Magnetic Resonance Imaging. Arthroscopy 2023; 39:592-599. [PMID: 36575108 DOI: 10.1016/j.arthro.2022.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/08/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the incidence of ramp lesions and posteromedial tibial plateau (PMTP) bone bruising on magnetic resonance imaging (MRI) in patients with multiligament knee injuries (MLKIs) and an intact anterior cruciate ligament (ACL). METHODS A retrospective review of consecutive patients surgically treated for MLKIs at 2 level I trauma centers between January 2001 and March 2021 was performed. Only MLKIs with an intact ACL that received MRI scans within 90 days of the injury were included. All MLKIs were diagnosed on MRI and confirmed with operative reports. Two musculoskeletal radiologists retrospectively rereviewed preoperative MRIs for evidence of medial meniscus ramp lesions (MMRLs) and PMTP bone bruises using previously established classification systems. Intraclass correlation coefficients were used to calculate the reliability between the radiologists. The incidence of MMRLs and PMTP bone bruises was quantified using descriptive statistics. RESULTS A total of 221 MLKIs were identified, of which 32 (14.5%) had an intact ACL (87.5% male; mean age of 29.9 ± 8.6 years) and were included. The most common MLKI pattern was combined injury to the posterior cruciate ligament and posterolateral corner (n = 27, 84.4%). PMTP bone bruises were observed in 12 of 32 (37.5%) patients. Similarly, MMRLs were diagnosed in 12 of 32 (37.5%) patients. A total of 8 of 12 (66.7%) patients with MMRLs demonstrated evidence PMTP bone bruising. CONCLUSIONS Over one-third of MLKI patients with an intact ACL were diagnosed with MMRLs on MRI in this series. PMTP bone bruising was observed in 66.7% of patients with MMRLs, suggesting that increased vigilance for identifying MMRLs at the time of ligament reconstruction should be practiced in patients with this bone bruising pattern. LEVEL OF EVIDENCE Level IV, retrospective case series.
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26
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Moran J, Jimenez AE, Katz LD, Wang A, McLaughlin WM, Gillinov SM, Patel RR, Kunze KN, Hewett TE, Alaia MJ, LaPrade RF, Medvecky MJ. Examining Preoperative MRI for Medial Meniscal Ramp Lesions in Patients Surgically Treated for Acute Grade 3 Combined Posterolateral Corner Knee Injury. Orthop J Sports Med 2023; 11:23259671221144767. [PMID: 36756171 PMCID: PMC9900669 DOI: 10.1177/23259671221144767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/13/2022] [Indexed: 02/05/2023] Open
Abstract
Background While medial meniscocapsular tears (ramp lesions) are commonly associated with isolated anterior cruciate ligament injuries, there are limited descriptions of these meniscal injuries in multiligament knee injuries (MLKIs). Purpose To (1) retrospectively evaluate preoperative magnetic resonance imaging (MRI) scans for the presence of ramp lesions in patients surgically treated for acute grade 3 combined posterolateral corner (PLC) knee injuries and (2) determine if a preoperative posteromedial tibial plateau (PMTP) bone bruise is associated with the presence of preoperative ramp lesions on MRI in these same patients. Study Design Cross-sectional study; Level of evidence, 3. Methods Data on consecutive patients at a level 1 trauma center with MLKIs between 2001 and 2021 were retrospectively reviewed. Only patients with acute grade 3 combined PLC injuries who received an MRI scan within 30 days of injury were assessed. Two musculoskeletal radiologists retrospectively reviewed each patient's preoperative MRI for evidence of ramp lesions and bone bruises. Intraclass correlation coefficients (ICCs) were used to calculate reliability among the reviewers. Multivariate analysis was used to evaluate the relationship between PMTP bruising and the presence of a ramp lesion on MRI. Results A total of 68 patients (79.4% male; mean age, 33.8 ± 13.7 years) with an acute grade 3 combined PLC injury were included in the study. On MRI, the ICCs for detection of ramp lesions and PMTP bone bruising were 0.921 and 0.938, respectively. Medial meniscal ramp lesions were diagnosed in 18 of 68 (26.5%) patients. Eleven of 18 (61.1%) patients with ramp lesions also showed evidence of PMTP bruising, while 13 of 50 (26.0%) patients without ramp lesions had PMTP bruising (P = .008). When controlling for age and sex, PTMP bruising was significantly associated with the presence of a ramp lesion in combined PLC injuries (odds ratio, 4.62; P = .012). Conclusion Preoperative medial meniscal ramp lesions were diagnosed on MRI in 26.5% of patients with acute grade 3 combined PLC injuries. PMTP bone bruising was significantly associated with the presence of a ramp lesion on MRI. These findings reinforce the need to assess for potential ramp lesions at the time of multiligament reconstruction.
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Affiliation(s)
- Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
- Jay Moran, BS, Department of Orthopaedics and Rehabilitation,
Yale School of Medicine, 367 Cedar Street, New Haven, CT 06511, USA (
) (Twitter: @JayMoran25)
| | - Andrew E. Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
| | - Lee D. Katz
- Department of Musculoskeletal Imaging, Yale School of Medicine, New
Haven, Connecticut, USA
| | - Annie Wang
- Department of Musculoskeletal Imaging, Yale School of Medicine, New
Haven, Connecticut, USA
| | - William M. McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
| | - Stephen M. Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
| | - Rohan R. Patel
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
| | - Kyle N. Kunze
- Hospital for Special Surgery–Weill Cornell Medical School, New York
New York, USA
| | | | - Michael J. Alaia
- Orthopedic Surgery, Division of Sports Medicine, New York University
Langone Health, New York, New York, USA
| | | | - Michael J. Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
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Cristiani R, van de Bunt F, Kvist J, Stålman A. High prevalence of meniscal ramp lesions in anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 2023; 31:316-324. [PMID: 36045182 PMCID: PMC9859899 DOI: 10.1007/s00167-022-07135-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/19/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate the prevalence of and factors associated with meniscal ramp lesions on magnetic resonance imaging (MRI) in patients with anterior cruciate ligament (ACL) injuries. METHODS Data from the Natural Corollaries and Recovery after ACL injury multicentre longitudinal cohort study (NACOX) were analysed. Only patients who underwent MRI were included in this study. All MRI scans were reviewed by an orthopaedic knee surgeon and a musculoskeletal radiologist. The patients were divided into two groups, those with and without ramp lesions according to MRI findings. Univariable and stepwise forward multiple logistic regression analyses were used to evaluate patient characteristics (age, gender, body mass index, pre-injury Tegner activity level, activity at injury) and concomitant injuries on MRI (lateral meniscus, medial collateral ligament [MCL], isolated deep MCL, lateral collateral ligament, pivot-shift-type bone bruising, posteromedial tibial [PMT] bone bruising, medial femoral condyle bone bruising, lateral femoral condyle [LFC] impaction and a Segond fracture) associated with the presence of meniscal ramp lesions. RESULTS A total of 253 patients (52.2% males) with a mean age of 25.4 ± 7.1 years were included. The overall prevalence of meniscal ramp lesions was 39.5% (100/253). Univariate analyses showed that contact sports at ACL injury, pivot-shift-type bone bruising, PMT bone bruising, LFC impaction and the presence of a Segond fracture increased the odds of having a meniscal ramp lesion. Stepwise forward multiple logistic regression analysis revealed that the presence of a meniscal ramp lesion was associated with contact sports at ACL injury [odds ratio (OR) 2.50; 95% confidence intervals (CI) 1.32-4.72; P = 0.005], pivot-shift-type bone bruising (OR 1.29; 95% CI 1.01-1.67; P = 0.04), PMT bone bruising (OR 4.62; 95% CI 2.61-8.19; P < 0.001) and the presence of a Segond fracture (OR 4.38; 95% CI 1.40-13.68; P = 0.001). CONCLUSION The overall prevalence of meniscal ramp lesions in patients with ACL injuries was high (39.5%). Contact sports at ACL injury, pivot-shift-type bone bruising, PMT bone bruising and the presence of a Segond fracture on MRI were associated with meniscal ramp lesions. Given their high prevalence, meniscal ramp lesions should be systematically searched for on MRI in patients with ACL injuries. Knowledge of the factors associated with meniscal ramp lesions may facilitate their diagnosis, raising surgeons' and radiologists' suspicion of these tears. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Riccardo Cristiani
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden. .,Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486, Stockholm, Sweden.
| | - Fabian van de Bunt
- grid.24381.3c0000 0000 9241 5705Division of Radiology, Department of Clinical Science, Karolinska University Hospital, Stockholm, Sweden
| | - Joanna Kvist
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden ,grid.5640.70000 0001 2162 9922Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - Anders Stålman
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden ,grid.416138.90000 0004 0397 3940Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486 Stockholm, Sweden
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Meniscal ramp lesions: a lot is known, but a lot is also unknown…. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07292-w. [PMID: 36544052 DOI: 10.1007/s00167-022-07292-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
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Bouguennec N, Thaunat M, Barth J, Cavaignac E, Gunepin FX, Letartre R, Netten A, Pujol N, Rousseau T, Sbihi J, Mouton C, Sfa TFAS. Consensus statement on data to be entered in the ACL tear registry: SFA-DataLake. Orthop Traumatol Surg Res 2022; 108:103392. [PMID: 36064107 DOI: 10.1016/j.otsr.2022.103392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) reconstruction is a frequent procedure, with room for improvement by rehabilitation measures and associated peripheral and meniscal surgeries that are currently under assessment, requiring follow-up. Outside France, there have been ACL registries for 20 years now. The French Arthroscopy Society (SFA) decided to set up an ACL tear registry within its SFA DataLake registry platform. MATERIAL AND METHOD This article presents the methodology underlying the ACL Tear Registry: i.e., identification, definition and coding of essential and relevant data. A test phase comprised an initial assessment to improve data quality and overall coherence, to optimize data-entry time for patients and practitioners, who are the guarantors of the registry's use and efficacy. RESULTS The SFA DataLake ACL Tear Registry was made available to SFA members in December 2021. It aims to enable a review of practices for surgeons, early detection of failure of procedures and implants, with rates of failure and abnormal complications, and identification of prognostic factors for outcome, especially regarding original items that do not figure in previous registries. CONCLUSION SFA DataLake strikes a balance between "indispensable" and "original" items. The choice of contents and data quality is founded on a robust methodology with overall coherence, enabling analysis of large cohorts and comparisons with the literature and other registries. However, it remains to assess rates of data entry and item relevance as the Registry progresses. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Mathieu Thaunat
- Ramsay santé, centre orthopédique Santy, hôpital privé Jean-Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Johannes Barth
- Clinique des Cèdres, 21, avenue Albert-Londres, 38130 Échirolles, France
| | - Etienne Cavaignac
- Clinique universitaire du sport, 1, place du Docteur Joseph-Baylac, 31300 Toulouse, France
| | - François-Xavier Gunepin
- Clinique mutualiste de la porte de l'Orient, 3 rue Robert-de-La-Croix, 56100 Lorient, France
| | - Romain Letartre
- Ramsay santé, hôpital privé la Louvière, 126, rue de la Louvière, 59800 Lille, France
| | | | - Nicolas Pujol
- Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Thomas Rousseau
- Clinique mutualiste catalane, 60, rue Louis-Mouillard, 66000 Perpignan, France
| | - Jaafar Sbihi
- Clinique Juge, 116, rue J.-Mermoz, 13008 Marseille, France
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, centre hospitalier Luxembourg, clinique d'Eich, Luxembourg, Luxembourg
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Age, male sex, higher posterior tibial slope, deep sulcus sign, bone bruises on the lateral femoral condyle, and concomitant medial meniscal tears are risk factors for lateral meniscal posterior root tears: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:4144-4155. [PMID: 35429241 DOI: 10.1007/s00167-022-06967-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Lateral meniscus posterior root tears (LMPRTs) are commonly found in patients with anterior cruciate ligament (ACL) injuries. However, risk factors for LMPRTs are not well known. This study was designed to systematically review the available evidence regarding risk factors associated with LMPRTs. METHODS The PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched for papers containing the key words "lateral meniscus posterior root tears", "LMPRTs" and "risk factor". Inclusion screening, data extraction, and quality assessment of the included articles were conducted independently by two authors. Statistical analysis was conducted to determine risk factors for LMPRTs. RESULT Seventeen studies with a total sample size of 6, 589 patients were identified. The pooled prevalence of LMPRTs was 9.6% (range, 5.1-33.8%) for ACL injury. Significant risk factors included a patient age of < 30 [OR = 1.4, 95% CI (1.07, 1.84), p = 0.01], male sex [OR = 1.50, 95% CI (1.24,1.81), p = 0.01], higher body mass index (BMI) [MD = 0.45, 95% CI (0.13, 0.76), p < 0.01], higher lateral posterior tibial slope (LPTS) [MD = 2.22, 95% CI (1.37, 3.07), p < 0.01], deep sulcus sign [OR = 5.76, 95% CI (1.35, 24.52), p < 0.01] and bone bruises on lateral femoral condyle [OR = 4.88, 95% CI (1.27, 18.77), p < 0.01], lateral meniscal extrusion > 1 mm [OR = 5.56, 95% CI (1.52, 20.29), p < 0.01] and > 3 mm [OR = 12.91 95% CI (1.28, 130.01), p < 0.01], medial meniscal tears [OR = 1.40, 95% CI (1.12, 1.75), p < 0.01], and medial ramp lesions [OR = 2.29, 95% CI (1.35, 3.89), p < 0.01]. CONCLUSION Age below 30, male, higher BMI, higher LPTS, deep sulcus sign, bone bruises on lateral femoral condyle, lateral meniscal extrusion, medial meniscal tear, and medial ramp lesion are risk factors for LMPRTs. LEVEL OF EVIDENCE Level IV.
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Green JS, Yalcin S, Moran J, McLaughlin WM, Medvecky MJ. Dual Posteromedial Portal Technique for Surgical Repair of an Unstable Medial Meniscal Ramp Lesion. VIDEO JOURNAL OF SPORTS MEDICINE 2022. [DOI: 10.1177/26350254221122583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Medial meniscal ramp lesions, which commonly occur in the setting of anterior cruciate ligament (ACL) ruptures, are defined as structural lesions at the medial meniscocapsular junction and can involve the posteromedial capsular attachments or most peripheral aspect of the meniscus. Unstable ramp lesions can lead to rotational instability within the knee and may play a role in ACL graft failure if left untreated. The novel use of dual posteromedial portals, similar to those used in an arthroscopic labral repair, may allow for enhanced visualization, optimal access to the posteromedial compartment, and easier manipulation of the instrumentation for successful surgical repair of hidden ramp lesions. Indications: Surgical repair of medial meniscal ramp lesions is indicated in patients with a clinically unstable meniscus when probed during arthroscopy. Technique Description: This surgical technique video demonstrates a dual posteromedial portal arthroscopic approach to repair an unstable medial meniscal ramp lesion using a case example from a patient with a concomitant ACL rupture. Results: Surgical repair of medial meniscal ramp lesions has been reported to show improvements in meniscus healing and knee stability. Discussion/Conclusion: The use of dual posteromedial portals offers improved accessibility to the posteromedial compartment of the knee and provides excellent visibility during the surgical repair of a medial meniscal ramp lesion. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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Affiliation(s)
| | - Sercan Yalcin
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Jay Moran
- Yale School of Medicine, New Haven, Connecticut, USA
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Foissey C, Thaunat M, Caron E, Haidar I, Vieira TD, Gomes L, Freychet B, Sonnery-Cottet B, Fayard JM. Combining Anterior Cruciate Ligament Reconstruction With Lateral Extra-Articular Procedures in Skeletally Immature Patients Is Safe and Associated With a Low Failure Rate. Arthrosc Sports Med Rehabil 2022; 4:e1941-e1951. [PMID: 36579042 PMCID: PMC9791843 DOI: 10.1016/j.asmr.2022.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 08/01/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose To analyze the rates of graft ruptures and growth disorders, the level of return to sport, and the clinical results of 2 lateral extra-articular procedures in growing children. Methods This study was a retrospective, single-center study of patients undergoing anterior cruciate ligament (ACL) surgery combined with 2 different lateral extra-articular procedures (anatomic reconstruction with a gracilis graft or modified Lemaire technique with a strip of fascia lata). The measurements of side-to-side anterior laxity and pivot shift were performed preoperatively and at the last follow-up. The sports level and the complications rate were assessed. The minimal clinically important differences (MCID) and patient acceptable symptoms state threshold scores were calculated. Results Thirty-nine patients (40 ACLs) were included (20 anatomic and 20 modified Lemaire) at an average follow-up of 57 months ± 10 [42-74]. One patient (2.5%) was lost to follow-up. The mean age at surgery was 13.8 ± 1.4 years old [9.8; 16.5]. One graft failure was reported (2.6% [0.06-13.5]) at 35.6 months after surgery. Two cases (5.4%) of femoral overgrowth were observed, and one of them required distal femoral epiphysiodesis. Ninety-two percent of the patients returned to sports. At the final follow-up, side-to-side anterior laxity was significantly improved, and no residual pivot shift was recorded in 95% of patients. Eighty-nine percent of the patients presented a Pedi-International Knee Documentation Committee score greater than the MCID postoperatively, and 77% presented a Lysholm score greater than the MCID. Conclusions This series of ACL reconstructions combined with 2 different lateral extra-articular procedures in skeletally immature patients demonstrated promising findings. The low rate of observed complications, including graft rupture and growth disturbance, is encouraging, but the small study population and lack of comparative group precludes reliable conclusions. Level of Evidence IV, therapeutic case series.
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Affiliation(s)
| | | | | | | | - Thais Dutra Vieira
- Address correspondence to Thais Dutra Vieira, M.D., Centre Orthopédique Santy, 24 avenue Paul Santy, 69008 Lyon, France.
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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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Gracia G, Cavaignac M, Marot V, Mouarbes D, Laumonerie P, Cavaignac E. Epidemiology of Combined Injuries of the Secondary Stabilizers in ACL-Deficient Knees: Medial Meniscal Ramp Lesion, Lateral Meniscus Root Tear, and ALL Tear: A Prospective Case Series of 602 Patients With ACL Tears From the SANTI Study Group. Am J Sports Med 2022; 50:1843-1849. [PMID: 35416066 DOI: 10.1177/03635465221092767] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Medial meniscal ramp lesion (MMRL), lateral meniscus root tear (LMRT), and anterolateral ligament (ALL) tear are individual injuries that have been described in patients who have an anterior cruciate ligament (ACL) tear. However, the prevalence of these lesions and their combination has not been defined. PURPOSES To define the individual and combined prevalence of MMRL, LMRT, and ALL tears in a case series of patients undergoing ACL reconstruction and to identify the risk factors for combined injuries. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients aged >15 years undergoing primary ACL reconstruction between January 2019 and June 2021 were enrolled in the study. A preoperative ultrasound scan was performed to look for an ALL tear. The presence of MMRL and LMRT was determined during a standardized arthroscopy exploration. A multivariate logistic regression model was used to determine the individual effect of patient variables on the risk of associated single, dual, triad, or tetrad injuries (MMRL, LMRT, ALL, ACL), represented by an adjusted odds ratio. RESULTS The case series consisted of 602 patients who underwent primary ACL reconstruction. An isolated ACL injury was present in 147 patients (24%). A dual injury was detected in 34 patients (6%) who had ACL-MMRL, 16 (2.65%) who had ACL-LMRT, and 265 (44%) who had ACL-ALL. A triad injury was detected in 80 patients (13.28%) who had ACL-ALL-MMRL, 36 (6%) who had ACL-ALL-LMRT, and 3 (0.5%) who had ACL-MMRL-LMRT. A tetrad injury pattern was detected in 21 patients (3.5%). Multivariate analysis showed that the occurrence of tetrad injury was significantly lower in older patients (adjusted odds ratio by year, 0.93 [95% CI, 0.88-0.99]; P = .028). Identifying LMRT increased the likelihood of finding MMRL-ALL injuries by 2.11 times (95% CI, 1.09-3.12; P = .031). CONCLUSION Isolated ACL tear is less common than combined injuries, which are quite frequent. Younger age is a risk factor for combined injuries. The search for damaged secondary stabilizers of the knee must be meticulous and systematic, especially when 1 injured structure has already been diagnosed.
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Affiliation(s)
- Gauthier Gracia
- Department of Orthopaedic Surgery, Polyclinique Côte Basque Sud, Saint-Jean-de-Luz, France
| | | | - Vincent Marot
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| | - Dany Mouarbes
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| | | | - Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
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Recent advances in ligamentous, meniscal and joint-preserving knee surgery: Pushing the limits. Orthop Traumatol Surg Res 2022; 108:103282. [PMID: 35452845 DOI: 10.1016/j.otsr.2022.103282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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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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Rodriguez AN, LaPrade RF, Geeslin AG. Combined Meniscus Repair and Anterior Cruciate Ligament Reconstruction. Arthroscopy 2022; 38:670-672. [PMID: 35248223 DOI: 10.1016/j.arthro.2022.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/04/2022] [Indexed: 02/02/2023]
Abstract
Meniscal tear patterns associated with anterior cruciate ligament (ACL) tears, such as root tears and ramp lesions are common but less easily recognized on magnetic resonance imaging (MRI) compared with a complete radial tear or a locked bucket-handle tear. Timely treatment of these tears improves outcomes in the setting of ACL reconstruction. While physical examination does not enable a definitive diagnosis of meniscal root tears and ramp lesions, high-grade laxity, including a 3+ Lachman and 3+ pivot shift, should raise suspicions for these tear patterns. MRI allows visualization of both root tears and ramp lesions, although the gold standard for diagnosis is probing at the time of arthroscopy due to a high false-negative rate on MRI. Up to 17% of patients with an ACL tear have a lateral meniscal root tear; a contact mechanism and increased posterior slope are both associated with a greater incidence of lateral meniscal root tears and these are repaired with a tunnel technique. Meniscal ramp lesions occur in up to 41% of patients with ACL tears due to a contact mechanism, and we prefer repair with an inside-out technique. More than 60% of complete radial meniscal tears occur in the setting of ACL tears and are preferentially repaired with a hashtag technique for minimally separated tears and a 2-tunnel technique combined with an inside-out repair for more severe tears. Bucket-handle tears are more common in the setting of chronic ACL deficiency; concurrent with ACL reconstruction urgent meniscal repair with an inside-out technique is the gold standard, which allows for precise approximation of the tear with multiple points of fixation for improved biomechanical performance. It is critical to identify and treat these tears during ACL reconstruction because of their role as secondary stabilizers and for long-term chondral protection.
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Affiliation(s)
| | | | - Andrew G Geeslin
- University of Vermont, Larner College of Medicine, Orthopaedics and Rehabilitation, Burlington, Vermont, U.S.A..
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Taneja AK, Miranda FC, Rosemberg LA, Santos DCB. Meniscal ramp lesions: an illustrated review. Insights Imaging 2021; 12:134. [PMID: 34564751 PMCID: PMC8464645 DOI: 10.1186/s13244-021-01080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/14/2021] [Indexed: 12/02/2022] Open
Abstract
The purpose of this review is to describe the anatomy and lesions affecting the peripheral portion of posterior horn of medial menisci (ramp lesions), along with illustrations and MRI cases. We will correlate imaging features with arthroscopic classification of ramp lesions. Also, postoperative and chronic changes related to meniscocapsular tears will be presented, as well as biomechanical consequences and treatment approach.
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Affiliation(s)
- Atul K Taneja
- Musculoskeletal Radiology Division, Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. .,Departamento de Imagem - Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Morumbi, São Paulo, SP, CEP 05652-900, Brazil.
| | - Frederico C Miranda
- Musculoskeletal Radiology Division, Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Laercio A Rosemberg
- Musculoskeletal Radiology Division, Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Durval C B Santos
- Musculoskeletal Radiology Division, Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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