Ramp lesions in ACL deficient knees in children and adolescent population: a high prevalence confirmed in intercondylar and posteromedial exploration

Malatray, Matthieu; Raux, Sébastien; Peltier, A.; Pfirrmann, Clémence; Seil, Romain; Chotel, Franck

doi:10.1007/s00167-017-4471-4

Cited by 46 publications

(66 citation statements)

References 26 publications

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“…Malatray et al found that the prevalence of ACL-associated ramp lesions in children and adolescents is similar to adult populations. 23 Liu et al also found that those younger than 30 years of age had a significantly higher incidence of ramp lesions. 20 The current study also identified several new significant risk factors, including revision ACLR.…”

Section: Risk Factors For Ramp Lesionsmentioning

confidence: 94%

Epidemiological Evaluation of Meniscal Ramp Lesions in 3214 Anterior Cruciate Ligament–Injured Knees From the SANTI Study Group Database: A Risk Factor Analysis and Study of Secondary Meniscectomy Rates Following 769 Ramp Repairs

et al. 2018

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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.

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Section: Risk Factors For Ramp Lesionsmentioning

confidence: 94%

Epidemiological Evaluation of Meniscal Ramp Lesions in 3214 Anterior Cruciate Ligament–Injured Knees From the SANTI Study Group Database: A Risk Factor Analysis and Study of Secondary Meniscectomy Rates Following 769 Ramp Repairs

et al. 2018

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“…20 Another study evaluating 56 pediatric and adolescent patients also reported the sensitivity of MRI to be 23%. 21 In our series, we found that in 80% (12/ 15) of patients RAMP lesion accompanied ACL rupture. We believe that in patients undergoing ACL reconstruction, examining the posterior horn of medial meniscus for the presence of instability is crucially important.…”

Section: Discussionmentioning

confidence: 54%

“…It is known that medial meniscus lesions caused increase in anterior translation of tibia and instability. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]24 ACL ruptures also increase anterior translation of tibia and also increase loading on meniscus by 200%. 25 On the other hand, in patients with total meniscectomy, the load on graft increased by 33 to 50% even when ACL reconstruction was performed.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, we included 15 patients: the number of male and female patients was eight and seven, respectively. The mean age of patients was 26.8 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) Inclusion criteria included age between 20 and 50, no history of knee surgery, interval between injury and surgery less than 3 months, and RAMP repair. Patients who did not meet the inclusion criteria were excluded.…”

Section: ► Acl ► Ramp ► Meniscocapsular Junctionmentioning

confidence: 99%

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Surgical Treatment of Meniscal RAMP Lesion

et al. 2019

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RAMP lesion, defined as peripheral detachment lesion of posterior horn of medial meniscus, has been shown to accompany anterior cruciate ligament (ACL) ruptures and is thought to play an important role in the knee joint stability. In this study, we aimed to present results of postoperative knee function scores and patient satisfaction after surgical repair of RAMP lesion. We included 15 patients who had undergone knee arthroscopy due to RAMP lesion in 2017. We recorded demographic data, diagnosis, pre- and postoperative International Knee Documentation Committee and Tegner–Lysholm scores of all patients. In this study, we included 15 patients: the number of male and female patients was eight and seven, respectively. The mean age of patients was 26.8 (18–35). Associated injuries included ACL rupture in 12 patients, additional medial meniscus lesion in 3 patients, lateral meniscus lesion in 3 patients, and superomedial patellar plicae syndrome in 2 patients. All patients had the same postoperative rehabilitation protocol. Mean preoperative Tegner–Lysholm knee score was 64.4 (53–75), while it was 82.5 (75–89) postoperatively, and mean preoperative and postoperative Visual Analogue Scale score at last postoperative follow-up were 5.26 (2–8) and 1.06 (0–2), respectively. All differences were found to be statistically significant. Meniscal RAMP lesions are commonly associated with ACL ruptures. RAMP repair significantly increases postoperative knee function scores and patient satisfaction following ACL reconstruction.

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“…Ramp lesions may be present in one in six adult patients with ACL injury, and the prevalence of ramp lesions in children with an ACL injury is similar to adults 95. The surgeon should be vigilant to verify the presence or absence of a medial meniscal ramp tear by visualising the posteromedial compartment.…”

Section: Consensus Methodsmentioning

confidence: 99%

2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

et al. 2018

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In October 2017, the International Olympic Committee (IOC) hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. The purpose of this consensus statement was to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America, and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. This consensus statement addresses 6 fundamental clinical questions regarding the prevention, diagnosis, and management of paediatric ACL injuries. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury.

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Ramp lesions in ACL deficient knees in children and adolescent population: a high prevalence confirmed in intercondylar and posteromedial exploration

Cited by 46 publications

References 26 publications

Epidemiological Evaluation of Meniscal Ramp Lesions in 3214 Anterior Cruciate Ligament–Injured Knees From the SANTI Study Group Database: A Risk Factor Analysis and Study of Secondary Meniscectomy Rates Following 769 Ramp Repairs

Epidemiological Evaluation of Meniscal Ramp Lesions in 3214 Anterior Cruciate Ligament–Injured Knees From the SANTI Study Group Database: A Risk Factor Analysis and Study of Secondary Meniscectomy Rates Following 769 Ramp Repairs

Surgical Treatment of Meniscal RAMP Lesion

2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

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