Background: Ramp lesions are characterized by disruption of the peripheral meniscocapsular attachments of the posterior horn of the medial meniscus. Ramp repair performed at the time of ACL reconstruction has been shown to improve knee biomechanics. Hypothesis/Purpose: Primary objectives of this study were to evaluate the incidence and risk factors for ramp lesions in a large series of patients undergoing ACL reconstruction, Secondary objectives were to determine the re-operation rate for failure of ramp repair, defined by subsequent re-operations for partial medial meniscectomy Study Design: Case series Methods: All patients underwent trans-notch posteromedial compartment evaluation of the knee during ACL reconstruction. Ramp repair was performed if a lesion was detected. Potentially important risk factors were analyzed for their association with ramp lesions. A secondary analysis of all patients who underwent ramp repair and had a minimum follow-up of two years was undertaken in order to determine the secondary partial meniscectomy rate for failed ramp repair. Results: The overall incidence of ramp lesions in the study population was 23.9% (769 ramp lesions in 3214 patients). Multivariate analysis demonstrated that the presence of ramp lesions was significantly associated with the following risk factors: male gender, patients aged under 30 years, revision ACLR, chronic injuries, pre-operative side-to-side laxity >6 mm and the presence of concomitant lateral meniscus tears. The secondary meniscectomy rate was 10.8% at a mean follow up of 45.6 months (24.2-66.2). Patients who underwent ACLR + ALLR had a greater than 2-fold reduction in the risk of reoperation for failure of ramp repair as compared with patients who underwent isolated ACLR (hazard ratio, 0.457; 95%CI, 0.226-0.864; P = .021) 3 Conclusion: There is a high incidence of ramp lesions in patients undergoing ACLR. The identification of important risk factors for ramp lesions in this study in an individual patient should help raise an appropriate index of suspicion and prompt posteromedial compartment evaluation. The overall secondary partial meniscectomy rate after ramp repair is 10.8%. Anterolateral ligament reconstruction appears to confer a protective effect on the ramp repair performed at the time of ACLR and results in a significant reduction in secondary meniscectomy rates.

Background: Reconstruction of the medial patellofemoral ligament (MPFL) is widely acknowledged as an integral part of the current therapeutic armamentarium for recurrent patellar instability. The procedure is often performed with concomitant bony procedures, such as distalization of the tibial tuberosity or trochleoplasty in the case of patella alta or high-grade trochlear dysplasia, respectively. At the present time, few studies have evaluated the clinical effectiveness of MPFL reconstruction as an isolated intervention. Purpose: To report the clinical outcomes of isolated MPFL reconstruction in cases of patellar instability and to identify predictive factors for failure. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of prospectively collected data was performed, including all patients who had undergone isolated MPFL reconstruction between January 2008 and January 2014. Preoperative assessment included the Kujala score, assessment of patellar tracking (“J-sign”), and radiographic features, such as trochlear dysplasia according to Dejour classification, patellar height with the Caton-Deschamps index (CDI), tibial tubercle–trochlear groove distance, and patellar tilt. The Kujala score was assessed postoperatively. Failure was defined by a postoperative patellar dislocation or surgical revision for recurrent patellar instability. Results: A total of 239 MPFL reconstructions were included; 28 patients (11.7%) were uncontactable and considered lost to follow-up. Thus, 211 reconstructions were analyzed with a mean follow-up of 5.8 years (range, 3-9.3 years). The mean age at surgery was 20.6 years (range, 12-48 years), and 55% of patients were male. Twenty-seven percent of patients had a preoperative positive J-sign, and 93% of patients had trochlear dysplasia (A, 47%; B, 25%; C, 15%; D, 6%). The mean CDI was 1.2 (range, 1.0-1.7); mean tibial tubercle–trochlear groove distance, 15 mm (range, 5-30 mm); and mean patellar tilt, 23° (range, 9°-47°). The mean Kujala score improved from 56.1 preoperatively to 88.8 ( P < .001). Ten failures were reported that required surgical revision for recurrent patellar instability (4.7%). Uni- and multivariate analyses highlighted 2 preoperative risk factors for failure: patella alta (CDI ≥1.3; odds ratio, 4.9; P = .02) and preoperative positive J-sign (odds ratio, 3.9; P = .04). Conclusion: In cases of recurrent patellar instability, isolated MPFL reconstruction would appear to be a safe and efficient surgical procedure with a low failure rate. Preoperative failure risk factors identified in this study were patella alta with a CDI ≥1.3 and a preoperative positive J-sign.