Isolated Meniscal Ramp Lesion Without Obvious Anterior Cruicate Ligament Rupture

Abstract

Objectives: The purpose of the present paper was to study isolated meniscal ramp lesions without obvious ACL rupture. Their biomechanical mechanisms were analyzed and their clinical characteristics were reviewed. The clinical effects of an all-inside horizontal mattress suture for isolated ramp lesions were evaluated. Materials and Methods: Twenty isolated meniscal ramp lesion patients without obvious ACL rupture from 2015 to 2017 were retrospectively reviewed. Preoperative MRI showed intact ACL and signs of ramp lesions. These isolated ramp lesions were arthroscopically confirmed and repaired through an all-inside horizontal mattress suturing method. MRI was performed 3 months postoperatively to assess isolated ramp lesion healing. The Tegner-Lysholm score and the visual analog scale score were recorded preoperatively and at 2 years postoperatively. The Wilcoxon rank sum test was performed to determine statistical significance. Results: Arthroscopic exploration confirmed isolated ramp lesions and longitudinal ACL splits or degeneration without obvious ACL rupture. MRI 3 months postoperatively showed healing of the isolated ramp lesions. At 2 years postoperatively, the VAS scores were significantly decreased and the Tegner-Lysholm scores were significantly increased. Knee function, without pain, was restored in all patients, including walking, climing and descending stairs, and squatting. Conclusion: Isolated meniscal ramp lesions without obvious ACL rupture may exist because of ACL longitudinal splits or degeneration and can be repaired through anterolateral and anteromedial portals with an all-inside horizontal-mattress suturing method.

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

“…The authors also reported a mean postoperative VAS score of 2.1 ± 1.4 and a mean Lysholm score of 85.7 ± 3.5 at the second-year follow-up. 18 In our study, where the mean follow-up period was 37.6 months, the mean VAS score was 2.34 ± 2.9, the Lysholm score was 85.37 ± 14.01, and the mean IKDC score was 85.32 ± 8.78. These results are in accordance with those of Jiang et al 18 .…”

“… 18 In our study, where the mean follow-up period was 37.6 months, the mean VAS score was 2.34 ± 2.9, the Lysholm score was 85.37 ± 14.01, and the mean IKDC score was 85.32 ± 8.78. These results are in accordance with those of Jiang et al 18 . Although the authors did not mention the tear types and their treatment approach in their study, they reported that outcomes were perfect.…”

“… 1 , 14 , 29 Almost all of these studies report the clinical outcomes of medial meniscal ramp lesions accompanied by ACL rupture. In our review, only the study of Jiang et al 18 reported the results of 20 patients treated arthroscopically for an isolated ramp lesion of the medial meniscus without ACL rupture. In their study, the authors did not report the subtypes of ramp lesions but stated that they believed these ramp lesions were due to ACL degeneration that healed over time.…”

“… 6 , 27 However, isolated ramp lesions without ruptured ACL have been reported as well. 18 In this latter study, the authors suggested that ramp lesions occur due to longitudinal splits and degenerations on the ACL, although they did not mention the types of ramp lesions treated. 18 …”

Ramp lesion of the medial meniscus

“… 12 , 13 Notably, isolated MRL may exist even in the absence of obvious ACL rupture, possibly as a sequalae of ACL longitudinal splits or degeneration. 14 MRL is also seen alongside root, horizontal and other types of medial meniscal tears. 15 However, the true incidence of MRL is unknown due to the high rate of mis or underdiagnosis resulting from low sensitivity of imaging modalities, 16 poor intra-operative visualization and surgical skills.…”