Management of ramp lesions of the knee: a systematic review of the literature

Alessio-Mazzola, Mattia; Lovisolo, Stefano; Capello, Andrea Giorgio; Zanirato, Andrea; Chiarlone, Francesco; Formica, Matteo; Felli, Lamberto

doi:10.1007/s12306-019-00624-z

Cited by 22 publications

(22 citation statements)

References 21 publications

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“…13,25 However, the trend is now to carry out arthroscopic repair of these tears, given the better healing potential and excellent functional outcomes. 3,7,10,16,27,31 Whether or not these lesions should be repaired is currently the subject of lively debate, and recent articles have suggested that some of these lesions may heal spontaneously and can be left in situ. 21 It seems essential to better define these lesions in terms of their characteristics (whether the lesion is complete, its size), locations (red zone, capsulosynovial junction), and stability (whether the meniscotibial ligament is affected) to serve as a basis for a specific treatment algorithm.…”

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confidence: 99%

Ramp Lesion Subtypes: Prevalence, Imaging, and Arthroscopic Findings in 2156 Anterior Cruciate Ligament Reconstructions

et al. 2021

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Background: Ramp lesions are defined as a particular type of injury within the posterior horn of the medial meniscus and its meniscocapsular attachments. Five subtypes have been described: type 1, meniscocapsular lesion; type 2, partial superior lesion; type 3, partial inferior lesion or hidden type; type 4, complete tear in the red zone; and type 5, complete double tear. Purpose: (1) To determine the prevalence of different subtypes of ramp lesions in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). (2) To describe the characteristics of ramp lesions based on imaging and diagnostic arthroscopy. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All patients who underwent arthroscopic ACLRs between November 2015 and November 2018 by 2 senior surgeons at 1 institution were evaluated retrospectively (1) to describe the subtypes of ramp lesions diagnosed intraoperatively using transnotch arthroscopic exploration of the posteromedial compartment and (2) to look for any factors significantly associated with these subtypes. The following parameters were studied: demographics; history and clinical findings including time between injury and surgery, side-to-side laxity, and pivot shift; lesions missed on magnetic resonance imaging (MRI) scans and medial proximal tibial bone contusion visible on MRI scans; and arthroscopic confirmation of ramp lesion (ie, prevalence), associated lateral meniscal tear, or medial chondral tear. Results: Out of 2156 primary or revision arthroscopic reconstructions, 334 ramp lesions were confirmed, giving a prevalence of 15.5%. The subtype distribution was as follows: type 1, 47.9%; type 2, 4.8%; type 3, 11.4%; type 4, 28.7%; type 5, 7.2%. Multivariate analysis showed that gross pivot shift was significantly associated with complete ramp tears (odds ratio, 4.8; 95% CI, 1.7-17.2). Hidden lesions (type 3, inferior partial tear in the red zone) were the most likely to be missed on preoperative MRI (45.9%). Conclusion: In a population undergoing ACLR, the prevalence of ramp lesions was 15.5%. Among the subtypes of ramp lesion, the most common was a meniscocapsular junction tear (type 1). Partial inferior tears (type 3) were the most likely to be missed on preoperative MRI scans. Gross pivot shift was significantly associated with complete ramp tears (types 1, 4, and 5).

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confidence: 99%

Ramp Lesion Subtypes: Prevalence, Imaging, and Arthroscopic Findings in 2156 Anterior Cruciate Ligament Reconstructions

et al. 2021

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“…9 Much of the literature regarding medial MCS focuses on younger athletes sustaining a twisting injury; however, our patients were middle aged with varied mechanisms of injury. 16,18 All 6 of our patients presented with lateral knee pain and locking symptoms that persisted despite months to years of conservative therapy. Additionally, our patients had normal examination results aside from LJL tenderness.…”

Section: Discussionmentioning

confidence: 93%

“…Many studies have designated medial MCS as an occult injury, citing anatomic location and limitations with MRI as the cause for missed diagnosis. 7,8,15,16 Greif et al 17 reviewed anatomic variants of medial MCS with associated MRI findings in an attempt to simplify and standardize the diagnosis. However, the modified classification relies on mechanism of injury, associated ACL injury and associated MRI findings for diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Diagnosis of Occult Posterolateral Meniscocapsular Separations: Another Hidden Lesion

Parisien

Shin

Boden

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose The purpose of this study was to describe the surgical findings and clinical outcomes in a series of patients with occult posterolateral meniscocapsular separations diagnosed arthroscopically after a negative magnetic resonance imaging (MRI) scan. Methods A retrospective analysis of prospectively collected data of consecutive patients who underwent surgical arthroscopy with repair of an occult posterolateral meniscocapsular separation by 2 fellowship-trained orthopaedic sports medicine surgeons at a single institution was performed. All lesions were identified arthroscopically in the posterolateral aspect of the lateral compartment as a distinct pathologic separation between the posterolateral capsule and adjacent meniscal tissue with increased excursion on probing. Clinical examination notes, MRI scans, and operative reports were reviewed. Patient-reported outcome measures were assessed via patient questionnaire. Results A total of 6 patients were included for analysis. MRI evaluation of the lateral meniscus was unrevealing in 4 patients, suggesting a possible tear of the body of the lateral meniscus in one patient and demonstrating a parameniscal cyst abutting the anterior root of the lateral meniscus in another patient. Arthroscopic examination revealed meniscocapsular separations of the posterolateral meniscus in all 6 knees, with 2 knees demonstrating concomitant bucket-handle meniscus tears. Patient-reported outcomes were determined for 67% of study patients. The average reported International Knee Documentation Committee score was 63.8, the average Knee Outcome Survey Activities of Daily Living Scale score was reported as 63, the 12-Item Short Form Survey (SF-12) Physical score averaged 46.8 with an average SF-12 Mental score of 59.9. Conclusions The diagnosis of occult posterolateral meniscocapsular separations (MCS) could be missed on advanced imaging, such as MRI, so arthroscopic diagnosis may be required. This study indicates that arthroscopic diagnosis and repair of occult posterolateral MCS results in good functional and clinical outcomes. Level of Evidence IV, therapeutic case series.

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“…In case of MRL extending medially into the meniscus, a hybrid technique can be applied in order to enhance structural stability by adding outside-in, inside-out or all-inside repair. 47 A new cadaveric study established that all-inside suture devices and other horizontal trajectory MRL repair techniques cannot anatomically repair the MTL as they cannot capture the tibial stump. In order for the MTL to be anatomically repaired, techniques such as suture hook repair that allow capturing both the meniscus and the MTL should be used.…”

Section: Arthroscopy and Repairmentioning

confidence: 99%

“…running, swimming) six months after surgery. 47 However, as mentioned earlier, there still is no consensus as to post-operative care. For instance, many doctors allow full weight-bearing directly after surgery and so on.…”

Section: Post-operative Periodmentioning

confidence: 99%

Ramp lesion of the medial meniscus

et al. 2021

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Ramp lesion of the medial meniscus used to be completely disregarded in the past. Ramp lesion has been now put under the spotlight by orthopaedic and sport medicine surgeons and requires attention. It is closely associated with anterior cruciate ligament injury. Major risk factors include chronic laxity, lateral meniscal lesion, anterior cruciate ligament reconstruction revision, anterolateral ligament tear concomitant with anterior cruciate ligament injury, time from injury, pre-operative side-to-side laxity > 6 mm, age < 30 years old, male sex, etc. Radiologists attempt to create diagnostic criteria for ramp lesion using magnetic resonance imaging. However, the only definite method to diagnose ramp lesion is still arthroscopy. Various techniques exist, among which posteromedial approach is the most highly recommended. Various treatment options are available. The success rate of ramp repair is very high. Major complications are uncommon. Cite this article: EFORT Open Rev 2021;6:372-379. DOI: 10.1302/2058-5241.6.200126

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Management of ramp lesions of the knee: a systematic review of the literature

Cited by 22 publications

References 21 publications

Ramp Lesion Subtypes: Prevalence, Imaging, and Arthroscopic Findings in 2156 Anterior Cruciate Ligament Reconstructions

Ramp Lesion Subtypes: Prevalence, Imaging, and Arthroscopic Findings in 2156 Anterior Cruciate Ligament Reconstructions

Arthroscopic Diagnosis of Occult Posterolateral Meniscocapsular Separations: Another Hidden Lesion

Ramp lesion of the medial meniscus

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