What did the study look at?
Meniscal ramp lesions are disruptions of the attachment that connects the back part of the medial meniscus to the shin bone (the posterior meniscotibial attachment). The authors note that these lesions are commonly associated with anterior cruciate ligament injuries, can often be missed on standard magnetic resonance imaging (MRI) and are difficult to treat.
The aim of this presentation is to describe how the authors repair ramp lesions using a minimally invasive "all-inside" technique.
How was it done?
This is a surgical technique presentation, not a study measuring outcomes in a group of patients. This summary is based on the article's abstract.
- The authors use the technique for tears involving the outer edge of the back part of the meniscus and its attachment to the joint capsule that allow the meniscus to move more than normal.
- The procedure uses standard arthroscopic portals, plus an additional portal at the back and inner side of the knee (posteromedial portal), positioned beforehand with a fine needle to give access around the lesion.
- Sutures are passed directly through the edges of the ramp lesion, and the repair is tensioned with arthroscopic knots.
- For more displaced tears, suture-passing instruments with two different curve directions may be needed to achieve an anatomical repair. The authors also describe using a long cannula in larger patients to allow instruments to pass.
What did it find?
As a technique presentation, it reports no patient outcomes. The advantages described by the authors are:
- A minimally invasive repair that avoids the inner-side incision and dissection needed for traditional "inside-out" repairs.
- Direct visualisation of the repair site, allowing an appropriately tensioned, anatomical repair.
The authors' conclusion
According to the authors, several technical points are critical to a good outcome: adequate arthroscopic visualisation of the back inner compartment of the knee so that a working portal can be created, passing sutures directly through the edges of the lesion, and tensioning the repair with arthroscopic knots to restore stability of the back of the meniscus.
Note: this article was prepared from the paper's abstract, as automated access to the publisher's site was blocked.
Reference
Vadhera AS, Parvaresh K, Swindell HW, Verma N, Gürsoy S, Evuarherhe A Jr, Chahla J, Verma N. Arthroscopic all-inside repair of meniscal ramp lesions. Journal of ISAKOS. 2022;7(4):82-83. Licence: CC BY-NC-ND 4.0 (according to the publisher's open-access record).
DOI: 10.1016/j.jisako.2022.04.004
Free full text: Journal of ISAKOS (PDF)
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
