Meniscal ramp lesions – Skillful neglect or routine repair?

Kaiser, Joshua T.; Meeker, Zachary D.; Horner, Nolan S.; Sivasundaram, Lakshmanan; Wagner, Kyle R.; Mazra, Armaan F.; Cole, Brian J.

doi:10.1016/j.jor.2022.05.001

Cited by 9 publications

(6 citation statements)

References 36 publications

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“…Degenerative meniscal damage is common in adults [ 14 , 27 ]. At present, the optimal management for non-traumatic, degenerative meniscal damage remains controversial [ 8 , 38 ].…”

Section: Introductionmentioning

confidence: 99%

No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review

Migliorini

Oliva

Eschweiler

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose It is unclear whether the results of arthroscopic partial meniscectomy (APM) are comparable to a structured physical therapy (PT). This systematic review investigated efficacy of APM in the management of symptomatic meniscal damages in middle aged patients. Current available randomised controlled trials (RCTs) which compared APM performed in isolation or combined with physical therapy versus sham arthroscopy or isolated physical therapy were considered in the present systematic review. Methods This systematic review was conducted according to the 2020 PRISMA statement. All the level I RCTs which investigated the efficacy of AMP were accessed. Studies which included elderlies with severe OA were not eligible, nor were those in which APM was combined with other surgical intervention or in patients with unstable knee or with ligaments insufficiency. The risk of bias was assessed using the software Review Manager 5.3 (The Nordic Cochrane Collaboration, Copenhagen). To rate the quality of evidence of collected outcomes, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used. Results Data from 17 studies (2037 patients) were collected. 48.5% (988 of 2037 patients) were women. The mean age of the patients was 52.7 ± 3.9 years, the mean BMI 27.0 ± 1.3 kg/m2. The current evidence suggests no difference in functional PROMs (quality of the evidence: high), clinical PROMs (quality of the evidence: high), pain (quality of the evidence: high), quality of life (quality of the evidence: high), physical performance measures (quality of the evidence: moderate), and OA progression (quality of the evidence: moderate). Conclusions The benefits of APM in adults with degenerative and nonobstructive meniscal symptoms are limited. The current evidence reports similarity in the outcome between APM and PT. Further long-term RCTs are required to investigate whether APM and PT produce comparable results using validated and reliable PROMs. Moreover, future RCTs should investigate whether patients who might benefit from APM exist, clarifying proper indications and outcomes. High quality investigations are strongly required to establish the optimal PT regimes. Level of evidence Level I.

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“…Degenerative meniscal damage is common in adults [ 14 , 27 ]. At present, the optimal management for non-traumatic, degenerative meniscal damage remains controversial [ 8 , 38 ].…”

Section: Introductionmentioning

confidence: 99%

No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review

Migliorini

Oliva

Eschweiler

et al. 2022

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…This may be true for some minor or stable lesions but not for larger tears qualified as unstable ramp lesions in a recent classification attempt [27]. To date, there is no clear evidence that the repair of stable ramp lesions results in superior subjective outcomes when compared with conservative treatment [19]. However, several studies have shown that meniscal ramp lesions result in increased anterior and rotational laxity in the ACL‐deficient knee [1, 23, 33] and that only their repair restores knee biomechanics [1, 33].…”

Section: Should Meniscal Ramp Lesions Always Be Repaired?mentioning

confidence: 99%

Meniscal ramp lesions: rediscovering the past

Cristiani

Stålman²,

Eriksson³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…Meniscal tears are common and increase with age [ 41 , 57 ]. Squatting, kneeling, crawling, chair sitting while driving, stair climbing, lifting items, and walking are associated with acute meniscal tears [ 39 , 61 , 79 ].…”

Section: Introductionmentioning

confidence: 99%

Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta‐analysis

Migliorini,

Schäfer,

Bell

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Meniscal tears are common and may impair knee function and biomechanics. This meta-analysis compared meniscal repair versus resection in patients with symptomatic meniscal tears in terms of patient-reported outcomes measures (PROMs), joint width, surgical failure, and rate of progression to osteoarthritis (OA) at conventional radiography. Methods This study was conducted according to the 2020 PRISMA statement. In August 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. Two reviewers independently performed the analysis and a methodological quality assessment of the included studies. All the clinical investigations which compared repair versus resection of meniscal tears were accessed. Results Data from 20 studies (31,783 patients) were collected. The mean BMI was 28.28 ± 3.2 kg/m2, and the mean age was 37.6 ± 14.0 years. The mean time elapsed from injury to surgery was 12.1 ± 10.2 months and the mean medial joint width was 4.9 ± 0.8 mm. Between studies comparability at baseline was found in age, women, BMI, time from injury to surgery and length of the follow-up, PROMs, medial joint width, and stage of OA. The resection group demonstrated a greater Lysholm score (P = 0.02). No difference was found in the International Knee Documentation Committee (P = 0.2). Nine studies reported data on the rate of failures at a mean of 63.00 ± 24.7 months. No difference was found between the two groups in terms of persistent meniscal symptoms (P = 0.8). Six studies reported data on the rate of progression to total knee arthroplasty at a mean of 48.0 ± 14.7 months follow-up. The repair group evidenced a lower rate of progression to knee arthroplasty (P = 0.0001). Six studies reported data on the rate of advanced knee OA at a mean of 48.0 ± 14.7 months of follow-up. The repair group evidenced a lower rate of advanced knee OA (P = 0.0001). No difference was found in the mean joint space width (P = 0.09). Conclusion Meniscal repair is associated with a lower progression to knee osteoarthritis at approximately six years of follow-up compared to partial meniscectomy. No difference in PROMs, medial joint width, and failures were evidenced. Level of evidence Level III, meta-analysis.

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Meniscal ramp lesions – Skillful neglect or routine repair?

Cited by 9 publications

References 36 publications

No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review

No evidence in support of arthroscopic partial meniscectomy in adults with degenerative and nonobstructive meniscal symptoms: a level I evidence-based systematic review

Meniscal ramp lesions: rediscovering the past

Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta‐analysis

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