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

Abstract

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.

Meniscal ramp lesion classification systems: A systematic review

“…Furthermore, Karaca et al performed an analysis where they retrospectively evaluated clinical outcomes after repairing type 3 hidden lesions [24]. The authors reported finding an MRI diagnostic sensitivity of 31.7% for this particular type of lesion when comparing MRI findings with direct arthroscopic evaluation [24].…”

“…Although Chagas‐Neto et al reported substantial and moderate intraobserver and interobserver agreement of the MRI diagnostic performance for this classification [9], another study reported a high rate of underdiagnosis of RLs (31.6%), with type 3 lesions being the most likely missed lesion (45.9%) on preoperative MRI [46]. Similarly, Karaca et al reported finding a diagnostic sensitivity of only 31.7% for type 3 lesions [24]. Taken together, these studies suggest that MRI may not be a reliable way to assess the different subtypes of RLs.…”

How to repair medial meniscal ramp lesions: A systematic review of surgical techniques

“…After the exclusion process detailed in Figure 1 , a total of 32 studies were included in our current concept review. Among these articles, 30 described an all‐inside suture technique [ 2 , 4 , 8 , 9 , 10 , 12 , 16 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 31 , 33 , 35 , 37 , 38 , 39 , 41 , 42 , 43 , 45 , 47 ]. Thirteen of them were related to an all‐inside suture through anterior arthroscopic portals [ 10 , 11 , 14 , 16 , 24 , 25 , 26 , 28 , 31 , 33 , 37 , 38 , 43 , 48 ] while eleven were related to an all‐inside suture through one posteromedial portal [ 4 , 8 , 12 , 16 , 21 , 22 , 41 , 42 , 43 , 44 , 47 ].…”

“…Among these articles, 30 described an all‐inside suture technique [ 2 , 4 , 8 , 9 , 10 , 12 , 16 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 31 , 33 , 35 , 37 , 38 , 39 , 41 , 42 , 43 , 45 , 47 ]. Thirteen of them were related to an all‐inside suture through anterior arthroscopic portals [ 10 , 11 , 14 , 16 , 24 , 25 , 26 , 28 , 31 , 33 , 37 , 38 , 43 , 48 ] while eleven were related to an all‐inside suture through one posteromedial portal [ 4 , 8 , 12 , 16 , 21 , 22 , 41 , 42 , 43 , 44 , 47 ]. Ten of the all‐inside suture studies through a posteromedial portal described the technique using a hook suture passer device [ 4 , 12 , ...…”

The Effect of Varying Sizes of Ramp Lesions in the ACL-Deficient and Reconstructed Knee: A Biomechanical Robotic Investigation

“…34 Subsequently, clinical studies investigating the outcome after ACLR and ramp repair reported clinically relevant improvements in postoperative outcome; however, they did not include a control group. 15,22,52 The only randomized controlled trial evaluating repair of RLs versus debridement and trephination of RLs during ACLR showed no significant difference in subjective scores, knee stability, and meniscal healing status with a follow-up of !2 years. 30 However, in this study, only stable RLs were observed.…”