Correlation between time from injury to surgery and the prevalence of ramp and hidden lesions during anterior cruciate ligament reconstruction. A new diagnostic algorithm

Vico, G. di; Donato, Sigismondo Luca Di; Balato, Giovanni; Correra, Gaetano; D’Addona, Alessio; Maffulli, Nicola; Rosa, Donato

doi:10.11138/mltj/2017.7.3.491

Cited by 8 publications

(5 citation statements)

References 21 publications

(23 reference statements)

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“…of this study was that the incidence of ramp lesions was 23.9% in ACL deficient knees. Previous authors have reported rates of diagnosis between 9% to 30%,6,10,11,15,20,36 but it has been unclear how reliably this data can be used to estimate the true incidence of ramp lesions due to the majority of studies including only a small number of patients. Bollen et al reported a rate of 9.3%, following arthroscopic examination, in a prospective series of 183 ACL reconstructions 6.…”

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confidence: 99%

“…Bollen et al reported a rate of 9.3%, following arthroscopic examination, in a prospective series of 183 ACL reconstructions 6. Di Vico et al reported a rate of 9.6% in a series of 115 patients who underwent ACL reconstruction 11. Liu et al reported a incidence of 16.6% in a series of 868 patients with ACL injury 20 and more recently, Seil et al reported a rate of 24% in 224 patients.…”

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confidence: 99%

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Epidemiological Evaluation of Meniscal Ramp Lesions in 3214 Anterior Cruciate Ligament–Injured Knees From the SANTI Study Group Database: A Risk Factor Analysis and Study of Secondary Meniscectomy Rates Following 769 Ramp Repairs

et al. 2018

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Background: Ramp lesions are characterized by disruption of the peripheral meniscocapsular attachments of the posterior horn of the medial meniscus. Ramp repair performed at the time of ACL reconstruction has been shown to improve knee biomechanics. Hypothesis/Purpose: Primary objectives of this study were to evaluate the incidence and risk factors for ramp lesions in a large series of patients undergoing ACL reconstruction, Secondary objectives were to determine the re-operation rate for failure of ramp repair, defined by subsequent re-operations for partial medial meniscectomy Study Design: Case series Methods: All patients underwent trans-notch posteromedial compartment evaluation of the knee during ACL reconstruction. Ramp repair was performed if a lesion was detected. Potentially important risk factors were analyzed for their association with ramp lesions. A secondary analysis of all patients who underwent ramp repair and had a minimum follow-up of two years was undertaken in order to determine the secondary partial meniscectomy rate for failed ramp repair. Results: The overall incidence of ramp lesions in the study population was 23.9% (769 ramp lesions in 3214 patients). Multivariate analysis demonstrated that the presence of ramp lesions was significantly associated with the following risk factors: male gender, patients aged under 30 years, revision ACLR, chronic injuries, pre-operative side-to-side laxity >6 mm and the presence of concomitant lateral meniscus tears. The secondary meniscectomy rate was 10.8% at a mean follow up of 45.6 months (24.2-66.2). Patients who underwent ACLR + ALLR had a greater than 2-fold reduction in the risk of reoperation for failure of ramp repair as compared with patients who underwent isolated ACLR (hazard ratio, 0.457; 95%CI, 0.226-0.864; P = .021) 3 Conclusion: There is a high incidence of ramp lesions in patients undergoing ACLR. The identification of important risk factors for ramp lesions in this study in an individual patient should help raise an appropriate index of suspicion and prompt posteromedial compartment evaluation. The overall secondary partial meniscectomy rate after ramp repair is 10.8%. Anterolateral ligament reconstruction appears to confer a protective effect on the ramp repair performed at the time of ACLR and results in a significant reduction in secondary meniscectomy rates.

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Epidemiological Evaluation of Meniscal Ramp Lesions in 3214 Anterior Cruciate Ligament–Injured Knees From the SANTI Study Group Database: A Risk Factor Analysis and Study of Secondary Meniscectomy Rates Following 769 Ramp Repairs

et al. 2018

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“…Two studies reported [ 22 , 40 ] assessment of RLs by probing from anterolateral portals, while two studies [ 28 , 32 ] reported adding a posteromedial portal to the protocol if an injury was suspected during probing from the anterolateral portal and three studies [ 7 , 38 , 48 ] reported using posteromedial portals in every patient (Yeo et al [ 86 ] did not specify the portals used during arthroscopy). Although, the evidence regarding the accuracy of different portals in the diagnosis of RLs during arthroscopy is conflicting [ 24 , 38 , 44 , 72 ], the adoption of different arthroscopic protocols by the studies may have affected our findings.…”

Section: Discussionmentioning

confidence: 98%

“…The general consensus is that arthroscopic evaluation is necessary to reliably assess the occurrence of a RL after ACL injury [ 13 ]. Standard anterolateral arthroscopy portals, even with the addition of probing, have limited accuracy, requiring insertion of the arthroscope in the posteromedial recess, using the Intercondylar (or Gillquist) view or a posteromedial portal [ 24 , 54 , 63 , 72 ].…”

Section: Introductionmentioning

confidence: 99%

Ramp lesions: a systematic review of MRI diagnostic accuracy and treatment efficacy

Moreira¹,

Almeida²,

Lunet³

et al. 2020

J EXP ORTOP

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Purpose We conducted a systematic review of the published literature to assess the accuracy of Magnetic Resonance Imaging (MRI) in establishing the presence of ramp lesions (RLs) in Anterior Cruciate Ligament (ACL) deficient knees and the clinical efficacy of the surgical repair of RLs. Methods A comprehensive search of the MEDLINE, Web of Science and Scopus databases was performed according to PRISMA guidelines. Studies assessing MRI diagnostic accuracy for RLs or the clinical effect of RL repair in participants with ACL injuries were included. Diagnostic accuracy measures were pooled and plotted in forest plots. Preoperative and at last follow-up treatment efficacy outcome measures were extracted and plotted in forest plots, for graphical comprehension. Results Sixteen studies met the criteria and were included. The diagnostic analysis showed a pooled sensitivity, specificity, positive and negative likelihood ratios of 65.1% (95% CI, 59.73 to 70.42), 91.6% (95% CI, 89.14 to 94.05), 2.91 (95% CI, 2.38–3.55) and 0.53 (95% CI, 0.44–0.64), respectively, with high heterogeneity (I2 above 80%) for all measures. Treatment analysis showed improved Lysholm Knee Score, IKDC score and laxity difference between the knees in all studies after meniscal suture repair. A separate analysis showed no differences between repair of smaller, stable, RLs with meniscal sutures and repair with abrasion and trephination only. Conclusion Although the results present considerable heterogeneity, MRI seems to demonstrate moderate accuracy in the diagnosis of RLs in patients with ACL tear and the surgical repair of RLs can be associated with improved overall outcomes.

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“…Subsequent to an ACL partial or complete injury, the relationship between passive stability and the functional stability of the knee joint is sometimes ambiguous [ 5 ]. Moreover, the diagnosis, treatment, and efficacy evaluation of the partial ACL injury remain challenging with conflicting reports in the literature [ 6 ]. When the ACL part tear develops, poor knee stability results in a greatly increased probability of joint injury.…”

Section: Introductionmentioning

confidence: 99%

The underlying mechanism of partial anterior cruciate ligament injuries to the meniscus degeneration of knee joint in rabbit models

Wang

et al. 2020

J Orthop Surg Res

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Background The diagnosis, treatment, and efficacy evaluation of anterior cruciate ligament (ACL) partial rupture remains controversial. This research aims to investigate the underlying mechanism of partial ACL injuries to the meniscus degeneration in the rabbit knee. Methods Sixty New Zealand white rabbits were randomly divided into three groups including an experimental group, a sham group (n = 6), and a blank control group (n = 6). The experimental group is composed of an anteromedial bundle (AMB) rupture group (n = 24) and a posterolateral bundle (PLB) rupture group (n = 24). Rabbits in the experimental group were subjected to right hind limbs knee surgery to induce ACL part injury under the arthroscopy. Finally, eight rabbits including 6 in the model group and 2 in the control group were sampled randomly on the 2nd, 4th, and 8th weeks respectively. We observed the typical form of the meniscus through HE staining. Expressions of inflammatory factors including interleukin-1β (IL-1β) and IL-17 in the knee joint fluid were determined by means of an ELISA. Analysis of the mRNA expressions of matrix metalloproteinases-13(MMP-13) was performed to evaluate the inflammatory mediators in the pathogenesis of the meniscus. Results HE staining results showed that the surface was rough and the tissues were loose displaying collagen fibers of varying thickness. Both IL-1β and IL-17 in the synovial fluid and the positive rate of MMP-13 in addition to MMP-13 mRNA showed a demonstrable increase treads from the 2nd to the 8th week. The significant difference was found (P < 0.05) compared to the control group. Conclusion We conclude that the elevated levels of IL-1β and IL-17, along with increased MMP13 expression, resulted in meniscus degradation in the rabbit knee joint model with partial ACL injury.

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Correlation between time from injury to surgery and the prevalence of ramp and hidden lesions during anterior cruciate ligament reconstruction. A new diagnostic algorithm

Cited by 8 publications

References 21 publications

Epidemiological Evaluation of Meniscal Ramp Lesions in 3214 Anterior Cruciate Ligament–Injured Knees From the SANTI Study Group Database: A Risk Factor Analysis and Study of Secondary Meniscectomy Rates Following 769 Ramp Repairs

Epidemiological Evaluation of Meniscal Ramp Lesions in 3214 Anterior Cruciate Ligament–Injured Knees From the SANTI Study Group Database: A Risk Factor Analysis and Study of Secondary Meniscectomy Rates Following 769 Ramp Repairs

Ramp lesions: a systematic review of MRI diagnostic accuracy and treatment efficacy

The underlying mechanism of partial anterior cruciate ligament injuries to the meniscus degeneration of knee joint in rabbit models

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