Surgical Treatment of Meniscal RAMP Lesion

Abstract

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.

Keywords

ACL - RAMP - meniscocapsular junction

• References

• 1 Peltier A, Lording TD, Lustig S, Servien E, Maubisson L, Neyret P. Posteromedial meniscal tears may be missed during anterior cruciate ligament reconstruction. Arthroscopy 2015; 31 (04) 691-698
• 2 Ahn JH, Bae TS, Kang KS, Kang SY, Lee SH. Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability. Am J Sports Med 2011; 39 (10) 2187-2193
• 3 Noyes FR, Chen RC, Barber-Westin SD, Potter HG. Greater than 10-year results of red-white longitudinal meniscal repairs in patients 20 years of age or younger. Am J Sports Med 2011; 39 (05) 1008-1017
• 4 Keene GC, Bickerstaff D, Rae PJ, Paterson RS. The natural history of meniscal tears in anterior cruciate ligament insufficiency. Am J Sports Med 1993; 21 (05) 672-679
• 5 Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am 1982; 64 (06) 883-888
• 6 Lorbach O, Kieb M, Herbort M, Weyers I, Raschke M, Engelhardt M. The influence of the medial meniscus in different conditions on anterior tibial translation in the anterior cruciate deficient knee. Int Orthop 2015; 39 (04) 681-687
• 7 Strobel MJ. Manuel of Arthroscopic Surgery. Berlin, Germany: Springer; 1998: 171-178
• 8 Bollen SR. Posteromedial meniscocapsular injury associated with rupture of the anterior cruciate ligament: a previously unrecognised association. J Bone Joint Surg Br 2010; 92 (02) 222-223
• 9 Chahla J, Dean CS, Moatshe G. , et al. Meniscal Ramp lesions: anatomy, incidence, diagnosis, and treatment. Orthop J Sports Med 2016; 4 (07) 2325967116657815
• 10 Liu X, Feng H, Zhang H, Hong L, Wang XS, Zhang J. Arthroscopic prevalence of ramp lesion in 868 patients with anterior cruciate ligament injury. Am J Sports Med 2011; 39 (04) 832-837
• 11 Stephen JM, Halewood C, Kittl C, Bollen SR, Williams A, Amis AA. Posteromedial meniscocapsular lesions increase tibiofemoral joint laxity with anterior cruciate ligament deficiency, and their repair reduces laxity. Am J Sports Med 2016; 44 (02) 400-408
• 12 Sonnery-Cottet B, Conteduca J, Thaunat M, Gunepin FX, Seil R. Hidden lesions of the posterior horn of the medial meniscus: a systematic arthroscopic exploration of the concealed portion of the knee. Am J Sports Med 2014; 42 (04) 921-926
• 13 Liu X, Zhang H, Feng H, Hong L, Wang XS, Song GY. Is it necessary to repair stable Ramp lesions of the medial meniscus during anterior cruciate ligament reconstruction? A prospective randomized controlled trial. Am J Sports Med 2017; 45 (05) 1004-1011
• 14 Edgar C, Ware J, Obopilwe E, Ziegler C, Reed D, Arciero RA. Posteromedial meniscocapsular tear: prevalance, detection sensitivity, biomechanics and repair technique. AAOS 2015 conference June 13 2016
• 15 Hatayama K, Kimura M, Ogoshi A, Takagishi K. Ramp lesion associated with anterior cruciate ligament rupture. Isakos meeting june 2013
• 16 Tienen TG, Buma P, Scholten JG, van Kampen A, Veth RP, Verdonschot N. Displacement of the medial meniscus within the passive motion characteristics of the human knee joint: an RSA study in human cadaver knees. Knee Surg Sports Traumatol Arthrosc 2005; 13 (04) 287-292
• 17 Seil R, VanGiffen N, Pape D. Thirty years of arthroscopic meniscal suture: What's left to be done?. Orthop Traumatol Surg Res 2009; 95 (8, Suppl 1) S85-S96
• 18 DePhillipo NN, Cinque ME, Chahla J, Geeslin AG, Engebretsen L, LaPrade RF. Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance Imaging in Patients With Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2017; 45 (10) 2233-2237
• 19 Arner JW, Herbst E, Burnham JM. , et al. MRI can accurately detect meniscal ramp lesions of the knee. Knee Surg Sports Traumatol Arthrosc 2017; 25 (12) 3955-3960
• 20 Seil R, Mouton C, Coquay J. , et al. Ramp lesions associated with ACL injuries are more likely to be present in contact injuries and complete ACL tears. Knee Surg Sports Traumatol Arthrosc 2018; 26 (04) 1080-1085
• 21 Malatray M, Raux S, Peltier A, Pfirrmann C, Seil R, Chotel F. Ramp lesions in ACL deficient knees in children and adolescent population: a high prevalence confirmed in intercondylar and posteromedial exploration. Knee Surg Sports Traumatol Arthrosc 2018; 26 (04) 1074-1079
• 22 Allen CR, Wong EK, Livesay GA, Sakane M, Fu FH, Woo SL. Importance of the medial meniscus in the anterior cruciate ligament-deficient knee. J Orthop Res 2000; 18 (01) 109-115
• 23 Indelicato PA, Bittar ES. A perspective of lesions associated with ACL insufficiency of the knee. A review of 100 cases. Clin Orthop Relat Res 1985; (198) 77-80
• 24 Mariani PP. Posterior horn instability of the medial meniscus a sign of posterior meniscotibial ligament insufficiency. Knee Surg Sports Traumatol Arthrosc 2011; 19 (07) 1148-1153
• 25 Papageorgiou CD, Gil JE, Kanamori A, Fenwick JA, Woo SL, Fu FH. The biomechanical interdependence between the anterior cruciate ligament replacement graft and the medial meniscus. Am J Sports Med 2001; 29 (02) 226-231
• 26 Peltier A, Lording T, Maubisson L, Ballis R, Neyret P, Lustig S. The role of the meniscotibial ligament in posteromedial rotational knee stability. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 2967-2973
• 27 Thaunat M, Jan N, Fayard JM. , et al. Repair of meniscal ramp lesions through a posteromedial portal during anterior cruciate ligament reconstruction: outcome study with a minimum 2-year follow-up. Arthroscopy 2016; 32 (11) 2269-2277
• 28 Ahn JH, Wang JH, Yoo JC. Arthroscopic all-inside suture repair of medial meniscus lesion in anterior cruciate ligament--deficient knees: results of second-look arthroscopies in 39 cases. Arthroscopy 2004; 20 (09) 936-945
• 29 Li WP, Chen Z, Song B, Yang R, Tan W. The fast-fix repair technique for Ramp lesion of the medial meniscus. Knee Surg Relat Res 2015; 27 (01) 56-60
• 30 DePhillipo NN, Cinque ME, Chahla J, Geeslin AG, Engebretsen L, LaPrade RF. Incidence and detection of meniscal Ramp lesions on magnetic resonance imaging in patients with anterior cruciate ligament reconstruction. Am J Sports Med 2017; 6 (04) e1315-e1320