Lesiones meniscales RAMP, y lesiones del ligamento meniscotibial posteromedial

Resumen

Las lesiones meniscales son las lesiones más frecuentemente asociadas a lesiones del Ligamento Cruzado anterior (LCA), encontrándose 9,3 a 16,9% en el segmento posteromedial y comprometiendo el ligamento meniscotibial. Descritas por Strobel por su apariencia artroscópica de rampa, se ha presentado su importancia dado el subdiagnóstico y el efecto biomecánico de una lesión posteromedial del menisco sobre el LCA y que su reparación restaura la traslación nativa de la tibia en conjunto con la reconstrucción del pivote central. Se ha demostrado que la mejor forma para diagnosticar lesiones ramp, es por visiones artroscópicas accesorias, una a través del surco intercondíleo y la otra por un portal posteromedial, logrando diagnosticar y manejar aquellas lesiones que sean inestables, a través de suturas dentro tanto por el portal anterior como por el posterior. Los resultados quirúrgicos son buenos, con mayor riesgo de falla en casos que la lesión se extiende al cuerpo meniscal. Es una lesión que debe buscarse bajo lupa, ya que pasarla por alto puede llevar a progresión de la lesión y a un mayor riesgo de rerotura del ligamento cruzado reconstruido.

Abstract

Meniscal tears are the most frequently associated lesions in Anterior Cruciate Ligament (ACL) rupture, 9.3 to 16.9% on them in the posteromedial segment compromising the meniscotibial ligament. Described by Strobel for its arthroscopic ramp appearance, has gained importance given the underdiagnosis and biomechanical effect of a posteromedial meniscal lesion on the ACL, and that its repair restores the native anterior tibial translation when the central pivot is also reconstructed. It has been shown that the best way to diagnose ramp lesions is by accessory portals, one through the intercondylar notch and the other through a posteromedial portal, useful to diagnose and repair those lesions that are unstable, through all-inside sutures within both Anterior and posterior portals. Surgical results are good, with increased risk of failure in cases where the lesion extends to the meniscal body. It is a lesion that must be looked for in a direct way, since misdiagnosing it can lead to ramp lesion progression and increased risk of re rupture of the reconstructed ACL.

Palabras Clave

menisco - rodilla - ligamentos de la rodilla - ramp meniscal

Keywords

meniscus - knee - knee ligament - meniscal ramp

• Referencias

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