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Classification and Surgical Repair of Ramp Lesions of the Medial Meniscus.

ABSTRACT: Ramp lesions of the medial meniscus are commonly associated with anterior cruciate ligament ruptures and consist of longitudinal peripheral tears of the posterior horn of the medial meniscus. Given the frequency of partial-thickness tears, they can be difficult to diagnose arthroscopically from the anterior compartment. We describe a classification of the different types of ramp lesions depending on both tear pattern (partial- or full-thickness tear) and associated meniscotibial ligament disruption. An original technique of arthroscopic suture placement through a single posteromedial portal with a 25° curved suture hook device is described.

SUBMITTER: Thaunat M

PROVIDER: S-EPMC5040630 | biostudies-literature | 2016 Aug

REPOSITORIES: biostudies-literature

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Classification and Surgical Repair of Ramp Lesions of the Medial Meniscus.

Thaunat Mathieu M Fayard Jean Marie JM Guimaraes Tales M TM Jan Nicolas N Murphy Colin G CG Sonnery-Cottet Bertrand B

Arthroscopy techniques 20160808 4

Ramp lesions of the medial meniscus are commonly associated with anterior cruciate ligament ruptures and consist of longitudinal peripheral tears of the posterior horn of the medial meniscus. Given the frequency of partial-thickness tears, they can be difficult to diagnose arthroscopically from the anterior compartment. We describe a classification of the different types of ramp lesions depending on both tear pattern (partial- or full-thickness tear) and associated meniscotibial ligament disrupt ...[more]

PMID: 27709051

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Technique for Medial Meniscus Ramp Repair: An Anatomic Approach.

Project description:Medial meniscus ramp lesions are commonly associated with anterior cruciate ligament injury. They are one of the causes of positive pivot shift and can lead to failure to obtain rotary stability if missed during the surgical procedure. Several repair methods use a suture lasso from 2 posteromedial portals to attach the posteromedial capsule to the meniscus. Because it was concluded at the consensus meeting of the European Society for Sports Traumatology, Knee Surgery and Arthroscopy in 2019 that ramp lesions are not considered a meniscal tear and the lesion is essentially in either the articular capsule, meniscal capsular ligament, or meniscotibial ligament (MTL), it should be considered as a peel-off injury of the posteromedial capsule. This lesion is a meniscocapsular separation with or without MTL injury. Thus, reattaching the capsule and MTL to the bone on the posteromedial aspect would provide adequate anatomical repair. The prevailing repair methods suture the capsule to the meniscus, ignoring the MTL attachment. This technique addresses the refixation of the meniscal capsular ligament and MTL to the bone where it is attached instead of suturing it to the meniscus, thus providing sounder anatomical repair.

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Meniscal Ramp Lesions Repair: An Under-Meniscus All-Inside Suture in Cases of Isolated Meniscotibial Ligament Tears.

Project description:Anterior cruciate ligament ruptures are commonly associated with ramp lesions of the medial meniscus. These posterior longitudinal peripheral tears induce medial meniscus instability and increase the anteroposterior and rotational knee laxity. We divided ramp lesions in 3 types: meniscocapsular ligament tears, meniscotibial ligament tears, and a combination of both lesions. The conventional surgical technique for treating meniscal ramp lesions is to use a suture hook device through a posteromedial approach, which is a complex process requiring a learning curve and extensive surgical time. An anterior approach often is criticized as underestimating the true incidence of ramp lesion and to offer insufficient operating space. The purpose of this technical note is to describe our arthroscopic repair technique in cases of isolated meniscotibial ligament tears. The suture is performed by an under-meniscus anterior approach with a percutaneous medial collateral ligament release to create an additional opening of the medial compartment. This simple procedure allows for accurate diagnoses of the meniscotibial lesions and enables repair of the lesions with an all-inside suture device without the usual drawbacks of a posteromedial approach.

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Increased Intra-Articular Internal Tibial Rotation Is Associated With Unstable Medial Meniscus Ramp Lesions in ACL-Injured Athletes: An MRI Matched-Pair Comparative Study.

Project description:PurposeTo 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).MethodsRetrospective 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.ResultsTwenty-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).ConclusionsUnstable MMRL concomitant to an ACL rupture was associated with an increased tibial internal rotation.Level of evidenceLevel III, retrospective comparative trial.

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Medial Meniscus Posterior Root Repair Using a Transtibial Technique.

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All arthroscopic medial meniscus inside out repair- Technical note.

Project description:Concomitant meniscal injuries are common in patients with anterior cruciate ligament (ACL) insufficiency. Along with ACL reconstruction, meniscal repair offers better outcomes. This requires multiple incisions for both procedures. We present a novel technique of medial meniscus inside out repair using only the tibial tunnel wound without making an additional posteromedial incision. This is the first such description of this novel technique in a 21 year old male who underwent ACL reconstruction along with bucket handle medial meniscal repair.

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