Arthroscopic all-inside ramp lesion repair using the posterolateral transseptal portal view

Keyhani, Sohrab; Ahn, Jin Hwan; Verdonk, René; Soleymanha, Mehran; Abbasian, Mohammadreza

doi:10.1007/s00167-016-4410-9

Cited by 46 publications

(51 citation statements)

References 16 publications

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“…It is possible to create 4 arthroscopic portals (anterolateral, anteromedial, medial parapatellar, posteromedial), and each one can be used as a either viewing or working portal, facilitating whole medial tibiofemoral joint visualization and instrument maneuvering, which is a precondition for proper tear site reduction and perpendicular suture placement, leading to improvement in healing rates 8 . Moreover, when a transnotch maneuver is performed, creation of a trans-septal portal for visualization of the posteromedial compartment is not necessary, reducing the risk of popliteal bundle injury 9 . Furthermore, this technique not only avoids MCL sectioning, which causes iatrogenic medial instability, but it also allows placement of the suture at the level of the MCL, resulting in stability for the MM.…”

Section: Discussionmentioning

confidence: 99%

Tips and Pearls for All-Inside Medial Meniscus Repair

Malinowski¹,

Góralczyk

Hermanowicz

et al. 2019

Arthroscopy Techniques

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The medial meniscus is one of the most commonly injured structures in the knee. When the importance of its proper function is well understood, an adequate management in meniscus tear is a key issue for whole knee joint well-being. Although it has been proven that meniscal repairs have better long-term results than meniscectomy, there is still no consensus as to which suturing technique is the best. An all-inside technique seems to allow for the most anatomic repairs with the greatest preservation of surrounding soft tissues. Our aim is to show that there are no technical limits for all-inside meniscal repairs with nonabsorbable sutures. We describe the technique and some tricks for medial meniscus repair in this Technical Note.

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Section: Discussionmentioning

confidence: 99%

Tips and Pearls for All-Inside Medial Meniscus Repair

Malinowski¹,

Góralczyk

Hermanowicz

et al. 2019

Arthroscopy Techniques

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“…This study was assessed to have a low overall risk of bias, according to the randomization process, blinding of the allocated intervention and unbiased outcome measurements. Blinding of the interventions to the investigators assessing the outcomes was only performed in one study, by Sonnery-Cottet et al [ 74 ], as was the case for prospective calculation of the study sample, performed only in the study by Keyhani et al [ 36 ].…”

Section: Resultsmentioning

confidence: 99%

Ramp lesions: a systematic review of MRI diagnostic accuracy and treatment efficacy

Moreira¹,

Almeida²,

Lunet³

et al. 2020

J EXP ORTOP

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Purpose We conducted a systematic review of the published literature to assess the accuracy of Magnetic Resonance Imaging (MRI) in establishing the presence of ramp lesions (RLs) in Anterior Cruciate Ligament (ACL) deficient knees and the clinical efficacy of the surgical repair of RLs. Methods A comprehensive search of the MEDLINE, Web of Science and Scopus databases was performed according to PRISMA guidelines. Studies assessing MRI diagnostic accuracy for RLs or the clinical effect of RL repair in participants with ACL injuries were included. Diagnostic accuracy measures were pooled and plotted in forest plots. Preoperative and at last follow-up treatment efficacy outcome measures were extracted and plotted in forest plots, for graphical comprehension. Results Sixteen studies met the criteria and were included. The diagnostic analysis showed a pooled sensitivity, specificity, positive and negative likelihood ratios of 65.1% (95% CI, 59.73 to 70.42), 91.6% (95% CI, 89.14 to 94.05), 2.91 (95% CI, 2.38–3.55) and 0.53 (95% CI, 0.44–0.64), respectively, with high heterogeneity (I2 above 80%) for all measures. Treatment analysis showed improved Lysholm Knee Score, IKDC score and laxity difference between the knees in all studies after meniscal suture repair. A separate analysis showed no differences between repair of smaller, stable, RLs with meniscal sutures and repair with abrasion and trephination only. Conclusion Although the results present considerable heterogeneity, MRI seems to demonstrate moderate accuracy in the diagnosis of RLs in patients with ACL tear and the surgical repair of RLs can be associated with improved overall outcomes.

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“…Keyhani et al. 22 describe the addition of the transseptal portal for more direct visualization of the ramp lesion, while suturing through the posteromedial portal with a 90° curved passer. However, in our experience, there are very lax tissues, and curved passers are not the most suitable instruments as they fail to correctly cover the lesion, further injuring the tissue or leaving untreated segments.…”

Section: Discussionmentioning

confidence: 99%

Meniscal Ramp Lesion Repair Using an All-Inside Technique

Negrín

Reyes

Iñiguez

et al. 2018

Arthroscopy Techniques

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Posteromedial meniscotibial ligament lesions, known as meniscal ramp lesions, are typically associated with ACL injuries, but frequently underdiagnosed. When correctly diagnosed, repair is mandatory in most cases. Retraction of the soft tissues makes it difficult to repair and leads to suture failure. Previously described techniques include all-inside and inside-out meniscal sutures, but do not ensure correct meniscotibial closure because of the soft tissue retraction. The purpose of this Technical Note is to describe a meniscal ramp lesion arthroscopic repair with an all-inside technique with the Fast-Fix 360 device, detailing the use of the accessory posteromedial portal, and the addition of an arthroscopic grasper that raises the retracted meniscotibial ligament, to allow correct fixation.

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Arthroscopic all-inside ramp lesion repair using the posterolateral transseptal portal view

Abstract: IV.

Cited by 46 publications

References 16 publications

Tips and Pearls for All-Inside Medial Meniscus Repair

Tips and Pearls for All-Inside Medial Meniscus Repair

Ramp lesions: a systematic review of MRI diagnostic accuracy and treatment efficacy

Meniscal Ramp Lesion Repair Using an All-Inside Technique

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