Incidence of Meniscal Ramp Lesion in Anterior Cruciate Ligament Reconstructions

Abstract

Objective To evaluate the incidence and epidemiological profile of meniscal ramp lesions in patients undergoing anterior cruciate ligament (ACL) reconstruction surgery, and to determine the related risk factors. Methods In total, 824 patients undergoing ACL reconstruction surgery were retrospectively analyzed. Patients who presented medial meniscal instability were submitted to evaluation of the posteromedial compartment of the knee. In case of injury, surgical repair was performed. Potential risk factors associated with the lesions were analyzed. Results The overall incidence of ramp lesions in the population studied was of 10.6% (87 lesions in 824 patients). The multivariate analysis through the Chi-squared test showed that the presence of meniscal ramp lesions was significantly associated with the following risk factors: right laterality and chronic lesions. Gender, age and sports activity were not statistically significant. Soccer was the most frequent cause of ramp injuries related to sport, with 78.2% of the cases. However, it was not shown to be a risk factor. The annual incidence from 2014 to 2019 ranged from 4.0% to 20.6%. Conclusion The incidence of meniscal ramp lesions was of 10.6% in ACL reconstruction surgeries, being more frequent among patients with chronic lesions. The increasing annual incidence ranged from 4.0% in 2014 to 20.6% in 2019.

Keywords: arthroscopy; epidemiology; knee; suture.

Fig. 1

Lateral view of the position of the lower limb during reconstruction of the anterior cruciate ligament (ACL), with the foot resting on the operating table, lateral support at the level of the tourniquet, and the knee at 90 ^o of flexion.

Fig. 2

Arthroscopy image of the space in the defined intercondyl through which the arthroscope is inserted to access the posteromedial compartment of the knee. The correct point is identified in the center of a triangle (in red) formed by the medial femoral condyle (MFC), the posterior cruciate ligament (PCL), and the tibia.

Fig. 3

Details of the opening of the posteromedial portal, with the arthroscope inserted in the posteromedial compartment of the knee. ( A ) The use of transillumination prevents iatrogenic injury to vessels and nerves. ( B ) The needle is inserted in the direction of the lesion, to define the best point to create the portal. ( C ) Under direct view, the portal is created with the use of a scalpel blade.

Fig. 4

Arthroscopy image, with the arthroscope located in the posteromedial compartment of the knee, evidencing the meniscal ramp lesion. The scraping and regularization of the edges of the meniscal ramp lesion is performed with a shaver blade. The outer portion of the medial meniscus (OMM) and the inner portion of the medial meniscus (IMM) are clearly visualized in the image.

Fig. 5

Arthroscopic image of the suture in the repair of the ramp lesion through the posteromedial portal of the knee. ( A ) The 25 ^o suture hook (SutureLasso, Arthrex, Naples, FL, United States) is inserted through posteromedial portal for the repair of the lesion. ( B ) The suture is performed with the use of simple stitches, and with the aid of a knot pusher ( B ).

Fig. 1

Vista lateral do posicionamento do membro inferior durante a reconstrução do ligamento cruzado anterior (LCA), com o pé apoiado sobre a mesa cirúrgica, apoio lateral no nível do torniquete, e joelho com flexão de 90 ^o .

Fig. 2

Imagem de artroscopia do espaço no intercôndilo definido por onde é inserido o artroscópio para acesso ao compartimento posteromedial do joelho. O ponto correto é identificado no centro de um triângulo (em vermelho) formado pelo côndilo femoral medial (CFM), ligamento cruzado posterior (LCP), e tíbia.

Fig. 3

Detalhes da confecção do portal posteromedial, com o artroscópio inserido no compartimento posteromedial do joelho. ( A ) O uso da transiluminação evita a lesão iatrogênica de vasos e nervos. ( B ) A agulha é introduzida na direção da lesão, para a definição do melhor ponto para criar o portal. ( C ) Sob visão direta, portal é criado com uso de uma lâmina de bisturi.

Fig. 4

Imagem da artroscopia, com o artroscópio localizado no compartimento posteromedial do joelho, evidenciando a lesão da rampa meniscal. A cruentização e regularização das bordas da lesão da rampa meniscal é realizada com uma lâmina de microdebridador. A porção externa do menisco medial (PEMM) e a porção interna do menisco medial (PIMM) são claramente visualizadas na imagem.

Fig. 5

Imagem artroscópica da realização da sutura no reparo da lesão da rampa através do portal posteromedial do joelho. ( A ) O gancho de sutura de 25 ^o (SutureLasso, Arthrex, Naples, FL, Estados Unidos) é introduzido pelo portal posteromedial para fazer o reparo da lesão. ( B ) A sutura é feita com uso de pontos simples e com o auxílio de um empurrador de nós.