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.
8Background: Lateral meniscal posterior root tears (LMPRT) result in loss of hoop forces 9 and significant increases in tibiofemoral contact pressures. Pre-operative imaging lacks 10 reliability and therefore holding an appropriate index of suspicion, based on the 11 epidemiology and risk factors for LMPRT, may reduce the rate of missed diagnoses. 12 Hypothesis/Purpose: The primary objectives of this study were to evaluate the incidence 13 and risk factors for lateral meniscus root lesions in a large series of patients undergoing 14 anterior cruciate ligament (ACL) reconstruction. 15 Study Design: Case series 16Methods: All patients who underwent primary or revision ACL reconstruction, between 17 January 2011 to April 2018 were considered for study eligibility. From this overall 18 population, all patients who underwent repair of a lateral meniscus posterior root tear 19 (LMPRT) were identified. The epidemiology of LMPRT was defined by the incidence 20 within the study population, stratified by key demographic parameters. Potentially 21 important risk factors for the presence of LMPRT were evaluated in multivariate logistic 22 regression analysis. 23Results: 3956 patients undergoing ACL reconstruction were included in the study. A 24LMPRT was identified and repaired in 262 patients (6.6%). Multivariate analyses 25 demonstrated that significant risk factors for LMPRT included a contact sports injury 26 mechanism (7.8% incidence with contact sports mechanism vs 4.5% with non-contact 27 mechanism 4.5%; OR = 1.69, IC95% 1.266 -2.285; P <.001) and the presence of a medial 28 meniscal tear (7.9% incidence with medial meniscal tear vs 5.8% in those without; OR = 29 1.532, IC95% 1.185 -1.979; P <.001). Although the incidence of LMPRT in male patients 30 (7.3%) was higher than females (4.8%) this was not significant in multivariate analysis (P 31 = 0.270). Patient age, revision ACL reconstruction and a pre-operative side to side laxity 32 difference of ≥ 6mm were not found to be significant risk factors for LMPRT. 33 Conclusion: The incidence of LMPRT was 6.6% in a large series of patients undergoing 34 ACL reconstruction. Participation in contact sports and the presence of a concomitant 35 medial meniscal tear were demonstrated to be important independent risk factors. Their 36 presence should raise the index of suspicion of this injury pattern. 37 38What is known about the subject: Previous reports on the epidemiology and risk factors 40 for LMPRT have all been limited by small study populations. This is an important 41 limitation because it reduces the confidence that can be held in the estimation of the true 42 incidence of these injuries. Understanding the epidemiology and risk factors for LMPRT 43 is of paramount importance because it is recognized that these injuries are likely to be 44 frequently missed and that left untreated can result in significant increases in tibiofemoral 45 compartment pressures and early arthritis. The recognized rate of missed diagnoses is due 46 to a lack of reliability of pre-operative ...
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