Background: Ramp lesions are defined as a particular type of injury within the posterior horn of the medial meniscus and its meniscocapsular attachments. Five subtypes have been described: type 1, meniscocapsular lesion; type 2, partial superior lesion; type 3, partial inferior lesion or hidden type; type 4, complete tear in the red zone; and type 5, complete double tear. Purpose: (1) To determine the prevalence of different subtypes of ramp lesions in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). (2) To describe the characteristics of ramp lesions based on imaging and diagnostic arthroscopy. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All patients who underwent arthroscopic ACLRs between November 2015 and November 2018 by 2 senior surgeons at 1 institution were evaluated retrospectively (1) to describe the subtypes of ramp lesions diagnosed intraoperatively using transnotch arthroscopic exploration of the posteromedial compartment and (2) to look for any factors significantly associated with these subtypes. The following parameters were studied: demographics; history and clinical findings including time between injury and surgery, side-to-side laxity, and pivot shift; lesions missed on magnetic resonance imaging (MRI) scans and medial proximal tibial bone contusion visible on MRI scans; and arthroscopic confirmation of ramp lesion (ie, prevalence), associated lateral meniscal tear, or medial chondral tear. Results: Out of 2156 primary or revision arthroscopic reconstructions, 334 ramp lesions were confirmed, giving a prevalence of 15.5%. The subtype distribution was as follows: type 1, 47.9%; type 2, 4.8%; type 3, 11.4%; type 4, 28.7%; type 5, 7.2%. Multivariate analysis showed that gross pivot shift was significantly associated with complete ramp tears (odds ratio, 4.8; 95% CI, 1.7-17.2). Hidden lesions (type 3, inferior partial tear in the red zone) were the most likely to be missed on preoperative MRI (45.9%). Conclusion: In a population undergoing ACLR, the prevalence of ramp lesions was 15.5%. Among the subtypes of ramp lesion, the most common was a meniscocapsular junction tear (type 1). Partial inferior tears (type 3) were the most likely to be missed on preoperative MRI scans. Gross pivot shift was significantly associated with complete ramp tears (types 1, 4, and 5).

Background: There is a lack of research on the management of ramp lesions associated with anterior cruciate ligament (ACL) injuries. Furthermore, there has been no report of the risk factors for failure of ramp lesion sutures, linked to either the technique used (all-inside suture implant vs suture hook through a posteromedial portal) or the type of lesion (location in the red zone or meniscocapsular junction, longitudinal extension, partial- or full-thickness tear). Purpose: To evaluate the results of arthroscopic repair of ramp lesions and determine the risk factors associated with ramp lesion repair failure, with special focus on their subtype and the suture technique. Study Design: Case-control study; Level of evidence, 3. Methods: All patients who underwent arthroscopic ramp lesion repair in association with ACL reconstruction between November 2015 and January 2018 were evaluated retrospectively. The following parameters were studied: demographics; clinical history; clinical findings including International Knee Documentation Committee score, complications, time from injury to surgery, side-to-side laxity, and pivot shift; and surgical findings including subtype, surgical management, and type and number of sutures. Failure of the ramp lesion repair was defined at secondary arthroscopy. Results: Among the 248 lesions analyzed, 18 (7.3%) failures were documented. The failures occurred in 21.1% of repairs managed with the all-inside device versus 4.3% of sutures managed with the suture hook ( P = .003). Among the 6 factors included in the Cox model, the only one identified as a risk factor for failure was the type of repair ( P = .003), with a risk for the all-inside device that was >5-fold higher than that for the suture hook repair (corresponding hazard ratio, 5.1 [95% CI, 1.8-14.5]). No other complications involving the surgical technique or device were registered. Conclusion: An arthroscopic all-inside technique of meniscal repair of ramp lesions appeared to be safe and effective. It provided excellent healing of the repaired meniscus, with an overall failure rate of 7.3%. The type of suture was associated with failure of the ramp lesion repair, with a significantly higher risk with the all-inside device than with suture hook repair sutures.

There has been renewed interest in anterior cruciate ligament (ACL) repair procedures in the past decade. Even though ACL reconstruction is still considered the gold standard, ACL repair is an alternative in selected patients. However, the risk of failure owing to isolated ACL repair remains a concern. Intra-articular augmentation has been proposed to protect the repair during the healing period. In the same way, the protective effect of anterolateral ligament reconstruction on the ACL graft is increasingly recognized. We describe a combined ACL repair and anterolateral ligament reconstruction technique with a single-strand gracilis for the intra-articular portion and as an anterolateral graft to protect the ACL repair during the healing phase.

Objectives: The initial clinical presentation of the discoid lateral meniscus (DLM) in children is highly variable and can be difficult to assess. The aim of this study was to focus on the meniscal instability associated with DLM and to correlate clinical, MRI and arthroscopic data. Methods: Between 2008 and 2018, 93 children and adolescents with 114 DLMs who underwent surgery in a referral center were included. Based on the anamnesis and clinical data, three types of meniscal instability of increasing severity were defined: occasional ("lock"), regular ("clock") and permanent ("block") instability. These findings were correlated with preoperative MRI data and arthroscopic findings according to Ahn’s classification, and as a result we were able to propose a DLM classification based on clinical or MRI data or both combined. Results: A wide variety of presentations was noted with 18 different types when clinical, MRI and arthroscopic characteristics were combined. 94% of the symptomatic DLMs for which surgery was performed showed instability due to meniscocapsular separation. Clinically, there were "lock", "clock" and "block" instability in 2%, 50% and 31% of DLMs respectively. Preoperative MRI indicated no meniscal shift and an anterocentral, posterocentral or central shift in 41%, 9%, 22% and 28% of the DLMs, respectively. Arthroscopic findings indicated no lesions, or an MC-A, MC-P or PLC type lesion in 6%, 46%, 15% and 33% of DLMs respectively. The most frequent presentations were “clocked” knees with MC-A lesions and “blocked” knees with PLC lesions. Only in 60% of the cases was a good level of correspondence noted between the different data. Conclusion: The association of meniscal instability and symptomatic DLM in children should be accepted as a certainty. “Locked”, “clocked” and “blocked” knees could represent different stages of increasing severity in the natural history of DLM instability.

Introduction: Ceramic-on-ceramic couplings are an alternative bearing surface to reduce the problems related to polyethylene wear and debris. However, ceramic articulations have their own risk of unique complications: fracture, squeaking, or dislocation. Few studies have assessed the outcomes of ceramic-on-ceramic total hip arthroplasties (THA) by direct anterior approach (DAA). The aim was to evaluate the early complications and revision rate of ceramic-on-ceramic THA by DAA. Material: A retrospective single-center study of 116 consecutive THAs was performed by DAA (106 patients) with ceramic-on-ceramic bearing from January 2015 to February 2018 with a minimum 24 months of follow-up. No patients were lost to follow-up. The mean age was of 55.3 years ± 11.3. The same cementless acetabular shell with a Biolox Delta ceramic insert and head were used. The complication and revision rates were collected at the last follow-up. The positioning of the acetabular implant was assessed on standard radiographs. Postoperative clinical outcomes were assessed by the Harris Hip Score. Results: At a mean follow-up of 31.9 months ± 5.5, no THA was revised. Five patients had late complications: 3 squeaking (2.6%) and 2 psoas impingements (1.7%) and were managed conservatively. All patients had satisfactory bony ingrowth of acetabular component, with no radiolucent lines and no osteolysis. Eight patients (6.9%) had an anterior overhang of the cup. The mean overhang for these patients was 4.1 mm. 111 hips (96%) were perceived as forgotten or having no limitations. Conclusion: This ceramic-on-ceramic coupling and shell by DAA produced excellent clinical outcomes and implant survival rate at a minimum two-year follow-up study. No serious complication was observed during the follow-up.

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Objectives: The lockdown during the COVID-19 crisis deprived the majority of patients who had undergone ACL surgery of access to their physical therapist. The objective of the study was to analyze the benefit of using a self-rehabilitation application to combat post-ligament reconstruction flexion contracture in the absence of rehabilitation during the lockdown. Methods: We conducted a retrospective study that compared 2 groups of patients who had undergone ACL reconstruction: the "App" group that underwent surgery between 10 February and 15 March 2020 were partially or totally deprived of access to a physiotherapist due to the COVID-19 lockdown and had completed rehabilitation using a self-rehabilitation application, and the "Physio" group that underwent surgery between 16 May and 23 December 2019 and had completed rehabilitation with a physiotherapist. Results: 148 patients were included in the study: 47 in the "App" group and 101 in the "Physio" group. Mean flexion contracture 3 weeks postoperatively was 1.3° +/- 3.8 in the "App" group versus 3.3° +/- 4 in the "Physio" group (p=0.002). The rate of flexion contractures was 45% in the “App” group and 65% in the “Physio” group (p=0.025). 71.4% of the patients acquired knee locking on weight-bearing with crutches in the "App" group, compared to 40.6% in the "Physio" group (p<0.01). No significant difference was noted between the two groups concerning the degree and rate of flexion contractures 6 weeks postoperatively and quadriceps recovery at 3 and 6 weeks postoperatively. Conclusion: Our study showed that the use of a self-rehabilitation application that targets flexion contracture control and quadriceps recovery in the first 6 weeks after ACL reconstruction provides similar results to a rehabilitation protocol by an independent physiotherapist.

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