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

Choi, Keun Young; Koh, In Jun; Kim, Man Soo

doi:10.1016/j.eats.2020.12.010

Cited by 7 publications

(9 citation statements)

References 19 publications

(34 reference statements)

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“…Choi et al. 1 created an all-inside suturing technique without the addition of the posteromedial portal by pie-crusting the medial collateral ligament. Despite avoiding the posteromedial portal, this technique causes a hitherto nonexistent lesion, correct debridement cannot be performed, nor can the meniscotibial ligament be shortened if it is retracted.…”

Section: Discussionmentioning

confidence: 99%

“…The dissociation between the capsule and posterior horn of the medial meniscus was first described in 1988 by Strobbel. 1 This injury was later called ramp lesion, and the importance of meniscotibial ligaments in its origin was identified. 2 The incidence of this lesion is 16% to 24% in patients with anterior cruciate ligament (ACL) injury, 3 making its correction and diagnosis important because neglecting it may cause residual rotary instability, 2 , 4 , 5 , 6 leading to early failure of ACL reconstruction and/or early degenerative knee disorders.…”

mentioning

confidence: 99%

“… 7 , 12 , 13 However, most have a long learning curve to be properly executed and to minimize the risks of neurovascular lesion, cartilage injury, as well as damage to the meniscotibial and meniscus. 1 , 7 , 13 , 14 , 15 …”

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confidence: 99%

See 2 more Smart Citations

All-Inside Technique for Ramp Lesion Repair: Arthroscopic Suture With Knee Scorpion Suture Passer

Neto¹,

Canuto²,

Girão³

et al. 2022

Arthroscopy Techniques

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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All-Inside Technique for Ramp Lesion Repair: Arthroscopic Suture With Knee Scorpion Suture Passer

Neto¹,

Canuto²,

Girão³

et al. 2022

Arthroscopy Techniques

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“…All unstable medial meniscus lesions were included (from a meniscocapsular separation or a “ramp lesion” to a longitudinal vertical tear [9, 16]). When surgeons found out there was a meniscus instability they systematically performed an all inside repair through anterior portals with suture anchors for longitudinal vertical tears or ramp lesions [4].…”

Section: Methodsmentioning

confidence: 99%

The crevice sign: a new indicator of meniscal instability in ACL reconstructions

Murgier

Bayle-Iniguez

Clatworthy

2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Meniscus preservation is key in knee surgery. The newly documented crevice sign indicates instability of the medial meniscus in ACL-deicient knees. Once the sign is visualised, it is imperative that the stability of the medial meniscus is assessed and potentially treated. It was hypothesized that there would be a strong correlation between the presence of an unstable medial meniscal tear in patients with the crevice sign in ACL-deicient knees. Methods This was a multicenter prospective study carried out to evaluate the incidence of medial meniscal tears in patients with ACL-deicient knees and their correlation with a crevice sign. All patients (128) who had undergone ACL reconstruction between May 2020 and November 2020 were assessed arthroscopically for meniscal stability and divided in to two groups: stable (n = 84) and unstable (n = 44). Thereafter, the presence of the crevice sign was determined in each case. ResultsThe populations were comparable in terms of sex and age (Table 1). Fisher's exact test showed a signiicant association between the presence of the crevice sign and the instability of the medial meniscus (p < 0.001). Descriptive statistics suggest that the presence of crevice sign was associated more frequently to MM instability (38.6% vs 1.2%; p < 0.001). The speciicity of this test was 98.8% and its sensitivity was 38.6%. The positive predictive value (PPV) was 94.4% and the negative predictive value (NPV) was 75.5%. ConclusionThe hypothesis was conirmed since medial meniscal instability was strongly correlated with the existence of the crevice sign and showed high speciicity and PPV. Level of evidence III.

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“…All-inside sutures (FAST-FIX 360° meniscal repair system; Smith & Nephew) were placed with vertical mattress configuration; the first anchor was inserted from the inferior aspect of the meniscus, entering through the meniscocapsular junction, while the second anchor was placed through the meniscus. 7 While the anterolateral portal was used as the visualization portal, the anteromedial portal was used as the working portal, and the tears were fixed with a sufficient number of all-inside sutures with 3 to 5 mm spacing ( Figure 1D ). After the repair, PHMM stability was evaluated again with the probe.…”

Section: Methodsmentioning

confidence: 99%

Short-Term Outcomes After Treatment of Isolated Hidden Meniscal Ramp Lesions

Karaca

Özbek

Ertan

et al. 2022

Orthopaedic Journal of Sports Medicine

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

Cited by 7 publications

References 19 publications

All-Inside Technique for Ramp Lesion Repair: Arthroscopic Suture With Knee Scorpion Suture Passer

All-Inside Technique for Ramp Lesion Repair: Arthroscopic Suture With Knee Scorpion Suture Passer

The crevice sign: a new indicator of meniscal instability in ACL reconstructions

Short-Term Outcomes After Treatment of Isolated Hidden Meniscal Ramp Lesions

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