Meniscal Ramp Lesion Repair by a Trans-septal Portal Technique

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.

Section: Discussionmentioning

confidence: 99%

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

Abdelrazek

Waly

Aziz

et al. 2020

“…A posteromedial portal in knee arthroscopic surgery is used for various indications, including arthroscopic posterior cruciate ligament (PCL) reconstruction, 1 PCL avulsion fracture fixation, 2 posterior medial meniscal repair, 3 medial ramp lesion repair, and synovectomy. 4 The posteromedial portal gives good access for visualization of the posteromedial compartment, posterior horn of the medial meniscus, and tibial PCL insertion and acts as a useful working portal.…”

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confidence: 99%

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confidence: 99%

“…Under arthroscopic visualization, the switching stick was passed through an anterolateral portal for a safer and easily reproducible approach to reach the posteromedial compartment of the knee, over which the arthroscope was shuttled and advanced into the posteromedial compartment. 4 McGinnis described using the posteromedial capsular folds to guide posteromedial portal placement in a cadaveric study. Kim et al reported a technique of creating the posteromedial portal by using an inside-out technique in the trans-notch view from the posterolateral portal.…”

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confidence: 99%

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Modified Surgical Technique of Making Posteromedial Portal in Knee Arthroscopy Using a Radiofrequency Device

Pathak

Kumar

Kulkarni

et al. 2020

In knee arthroscopy, a posteromedial portal is used for various indications including arthroscopic posterior cruciate ligament reconstruction, posterior cruciate ligament avulsion fracture fixation, posterior medial meniscal repair, medial ramp lesion repair, and synovectomy. Making the posteromedial portal is challenging for young and even experienced surgeons. Creating the posteromedial portal in knee arthroscopy is challenging and technically demanding for surgeons because of the thick muscular cover, proximity of the neurovascular bundle, tenacious tough capsule, and excessive fat deposition in the posteromedial knee and thigh region. Access for viewing the posteromedial compartment during different procedures is made simple, safe, and replicable with this technique of creating the posteromedial portal. This article describes a simple way to create the posteromedial portal using a radiofrequency device by a modified outside-in surgical technique.

“…Proposed methods of increasing medial compartment visualization include the use of a 70° arthroscope placed through the intercondylar notch (Gillquist maneuver), 4 creation of a posteromedial portal, 5 or relaxation of the deep medial collateral ligament (MCL) 6, 7, 8, 9, 10, 11, 12. The use of a 70° arthroscope or a posteromedial portal may provide adequate visualization of the tear but will not improve the working room for instrumentation.…”

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confidence: 99%

Relaxation of the Medial Collateral Ligament to Facilitate Pediatric Meniscal Surgery

Sherman

Harrah

Schlechter

2019

Meniscal injuries are becoming increasingly common in the pediatric population. During arthroscopic evaluation, pediatric patients typically have pristine articular cartilage and tight medial joint spaces. Therefore, when an arthroscope enters the medial compartment, iatrogenic damage to the articular cartilage may occur. Additionally, proper visualization of the medial meniscus (posterior horn or meniscocapsular junction) can prove to be difficult, and potential pathology may be missed. Proposed methods of increasing medial compartment visualization include the use of a 70° arthroscope placed through the intercondylar notch (Gillquist maneuver), creation of a posteromedial portal, or relaxation of the deep medial collateral ligament (MCL). Similar techniques have been described for use in adults for partial meniscectomy, but not in the pediatric population. The purpose of this Technical Note is to describe the steps to successfully perform the relaxation technique for meniscal repairs in pediatric patients, using an extra-articular outside-in percutaneous method.