Different Techniques for the Management of Meniscal Ramp Lesions Using Standard Anterior Portals

Abstract

There is strong association between meniscal lesions and anterior cruciate ligament injuries. Recently, light was shown on a new entity: ramp lesions. The incidence of these lesions and their management is still unclear. Although some believe that some lesions, when stable, can be managed conservatively, most surgeons repair ramp tears. Accessibility of these tears is challenging; they are best accessed through posterior portals, which is time-consuming and poses potential risk to vital structures. Our technique allows access to and management of ramp lesions through safe standard anterior portals. Ramp lesions are searched for as a routine step during anterior cruciate ligament reconstruction by advancing the scope through the intercondylar notch just beside the medial femoral condyle. If a lesion is found, it is repaired; only very stable small tears are treated with needling to refresh the edges and induce a healing response. A simple suture, horizontal mattress suture, or a circumferential stitch is used.

Medial Meniscal Ramp Lesion Repair Through Anterior Portals Using a Medial Collateral Ligament Pie-Crusting Technique

“…4,9,15 However, to our knowledge, no techniques have been reported that enable full visualization of the ramp lesion directly from the anterior compartment using an arthroscope placed through the anterolateral portal (without posteromedial visualization through the intercondylar notch) and repair of the lesion from the anteromedial portal using an MCL pie-crusting technique. Although Mostafa Zaky Abdelrazek et al 8 introduced a technique to repair ramp lesions using standard anterior portals, they visualized the posteromedial compartment by positioning the arthroscope through the intercondylar notch, which requires a high level of surgical skill.…”

“…Unlike previous reports that introduced MCL release as a technique only for patients with a tight medial compartment, we use this technique in all cases; it allows direct anterior visualization of the posteromedial part of the medial meniscus from the anterolateral portal. 8 Many previous studies have established that MCL release is a safe and minimally harmful technique. [16][17][18][19] MCL pie crusting has typically generated grade I MCL laxity without saphenous nerve or vein By means of medial collateral ligament release, the ramp lesion, which is usually covered by the medial femoral condyle, can be seen from the standard anterolateral viewing portal.…”

“…7 However, it is challenging and requires more surgical skill because there is some risk of damage to the posterior neurovascular structures and articular cartilage. 7 Under these circumstances, Mostafa Zaky Abdelrazek et al 8 introduced a technique to repair ramp lesions using standard anterior portals. This technique provides convenient and reliable repair of ramp lesions through standard anterior portals using the FasT-Fix 360 Meniscal Repair system (Smith & Nephew, Andover, MA).…”

“… 7 Under these circumstances, Mostafa Zaky Abdelrazek et al. 8 introduced a technique to repair ramp lesions using standard anterior portals. This technique provides convenient and reliable repair of ramp lesions through standard anterior portals using the FasT-Fix 360 Meniscal Repair system (Smith & Nephew, Andover, MA).…”

“…However, this technique requires visualization of the ramp lesion with a light source through the intercondylar notch, which can be challenging for inexperienced surgeons, especially in tight knees. 8 We thus introduce a technique for repairing ramp lesions under anterior visualization using a medial collateral ligament (MCL) pie-crusting technique ( Video 1 ).…”