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. 2024 Jan 1;13(2):102846.
doi: 10.1016/j.eats.2023.09.021. eCollection 2024 Feb.

Anchor-Based Meniscal Ramp Repair

Elizabeth Marks Benson  1 , Audria Wood  1 , Chandler Harris  1 , Patrick Smith  2 , John Xerogeanes  3 , Aaron Casp  1 , Amit Momaya  1
Affiliations

Anchor-Based Meniscal Ramp Repair

Elizabeth Marks Benson et al. Arthrosc Tech. .

Abstract

Ramp lesions of the medial meniscus are underdiagnosed because of difficulty in visualizing via magnetic resonance imaging and during arthroscopy. They most often occur simultaneously with anterior cruciate ligament (ACL) injury but may also be associated with posterior plateau contusions, steeper medial tibial plateau slope, and excess varus alignment. Upwards of 24% of ACL reconstructions have concomitant ramp lesions. Failure to repair the ramp lesion is associated with increased rotational laxity, tibial translocation, persistent pivot shift, and poorer outcomes after ACL reconstruction. The purpose of this article is to describe an all-suture anchor-based repair of a meniscal ramp lesion, which confers several advantages over traditional repair techniques.

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Conflict of interest statement

The authors report the following potential conflicts of interest or sources of funding: A.M. reports board membership/owner/officer/committee appointments for Arthroscopy; is a paid consult or employee for Arthrex and Fidia Pharma USA; and is an unpaid consultant for Miach Orthopaedics and Reparel. P.S. reports board membership/owner/officer/committee appointments for Arthroscopy, the American Orthopaedic Society for Sports Medicine, and the Journal of Knee Surgery; royalties from Arthrex; Speakers bureau/paid presentations from Arthrex; research or institutional support from Arthrex; stock or stock options from Spinal Simplicity; is a paid consultant or employee for Arthrex. J.X. reports royalties from Arthrex; and stock or stock options from My-Eye; is a paid consultant or employee for Arthrex and Trice Medical. A.C. is a paid consultant or employee for Arthrex. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

Figures

Fig 1
Fig 1
Required instrumentation specific to this technique. Shown equipment includes drill and 1.8 mm drill bit (top row from left to right); spinal needle, switching stick, cannula, debridement tool, 1.8 mm FiberTak soft anchors (Arthrex, Naples, FL), SutureLasso (Naples), suture grabber, and suture cutter (bottom row from left to right).
Fig 2
Fig 2
The patient remains supine with the knee flexed to approximately 90°. A probe is used in the posteromedial compartment to evaluate the ramp lesion. Probing the ramp lesion can help determine size, stability, and location of the lesion.
Fig 3
Fig 3
A cadaveric limb is pictured; a normal operating setting would position the patient supine with the knee supported by an L-bar at approximately 90°. A spinal needle is inserted to localize the posteromedial portal under direct visualization to ensure correct trajectory and placement to prevent injury to the saphenous vein and nerve.
Fig 4
Fig 4
A shaver is inserted into the posteromedial compartment and used to biologically prepare the medial tibial plateau to facilitate healing after the ramp repair.
Fig 5
Fig 5
The all-suture knotless anchor has been placed along the posteromedial tibial plateau. The SutureLasso (Arthrex, Naples, FL) is used to capture the posteromedial capsule tissue. The repair stitch is then passed through this lasso. Once passed, the repair stitch is then placed into the soft tissue passing suture and tensioned down.
Fig 6
Fig 6
The completed repair is shown after the suture is cut flush, and a probe is used to assess the stability of the repair. After completion, attention is directed toward concomitant pathology of the knee.
See this image and copyright information in PMC

References

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