Anchor-Based Meniscal Ramp Repair
Ontology highlight
ABSTRACT:
SUBMITTER: Benson E
PROVIDER: S-EPMC10907898 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:Meniscal ramp lesions have been reported to be present in 9% to 17% of patients undergoing anterior cruciate ligament reconstruction. Detection at the time of arthroscopy can be accomplished based upon clinical suspicion and careful evaluation without the use of an accessory posteromedial portal. Options for surgical treatment include arthroscopic repair using an all-inside or inside-out technique. The purpose of this Technical Note is to detail our arthroscopic inside-out repair technique for meniscal ramp lesions.
| S-EPMC5622282 | biostudies-literature
Project description:The management of medial meniscus ramp lesions can be challenging. The current gold standard technique to repair these lesions is the transnotch view combined with a single instrumental posteromedial portal. However, it does not provide direct visualization of the ramp and does not allow for an anatomic repair. In this Technical Note, a new technique is described with 2 posteromedial portals: a posteromedial viewing portal and working portal. This 2-portal approach aims to improve visualization of the lesion and its repair, as well as allow for a technically easier repair.
| S-EPMC9353068 | biostudies-literature
Project description:Posteromedial meniscotibial ligament lesions, known as meniscal ramp lesions, are typically associated with ACL injuries, but frequently underdiagnosed. When correctly diagnosed, repair is mandatory in most cases. Retraction of the soft tissues makes it difficult to repair and leads to suture failure. Previously described techniques include all-inside and inside-out meniscal sutures, but do not ensure correct meniscotibial closure because of the soft tissue retraction. The purpose of this Technical Note is to describe a meniscal ramp lesion arthroscopic repair with an all-inside technique with the Fast-Fix 360 device, detailing the use of the accessory posteromedial portal, and the addition of an arthroscopic grasper that raises the retracted meniscotibial ligament, to allow correct fixation.
| S-EPMC5989817 | biostudies-literature
Project description:A ramp lesion is a specific type of tear in the meniscocapsular junction of the posterior horn of the medial meniscus, usually associated with anterior cruciate ligament (ACL) injury. Biomechanical cadaveric studies have shown that ACL injury combined with ramp lesions significantly increases anterior tibial translation and external rotation, which ACL reconstruction alone cannot completely control. Additionally, ramp lesions are sometimes associated with medial meniscal defects, especially in cases of chronic ACL deficiency after repetitive traumatic events, in which the anatomical repair of the meniscocapsular junction is infeasible. This report describes a new arthroscopic repair technique using an all-suture anchor through a posteromedial portal for unstable ramp lesions with medial meniscal defects.
| S-EPMC10628196 | biostudies-literature
Project description:The identification of meniscal ramp lesions can be quite difficult or even impossible with conventional anterior arthroscopic viewing and working portals. Although even the use of transnotch viewing maneuvers into the posteromedial compartment increases the likelihood of diagnosis, it is the posteromedial and trans-septal portals that provide the best direct visualization of these many times "hidden lesions." In this surgical technique description, we describe a method to not only adequately visualize the ramp lesion, but also provide subtle variations to existing surgical techniques that can help limit injury to neurovascular structures as well as gain satisfactory vertical suture repair of this posteromedial meniscocapsular injury.
| S-EPMC5622595 | biostudies-literature
Project description:The surgical management of medial meniscus ramp lesions can be challenging. Currently, repairs are performed via a trans-notch view, combined with a single posteromedial working portal. This technique, however, does not allow for a direct and complete visualization of the structures being injured, making a precise appreciation of the injured structures, as well as an anatomical repair, difficult. To overcome this limitation, a 2-portal posteromedial approach has recently been described. It allows better visualization of the mediolateral extent of the tear and a precise identification of the injured structures. In this Technical Note, an anatomic repair technique using this approach is presented. It consists of a double-row of sutures to repair individually both the meniscotibial and meniscocapsular ligament, thus restoring the 2 main components of the posterior horn of the medial meniscus to their natural insertion site.
| S-EPMC10533853 | biostudies-literature
Project description:Medial meniscus ramp lesions are commonly associated with anterior cruciate ligament injuries. These lesions were defined previously as longitudinal tears around the meniscocapsular junction at the level of the posterior horn of the medial meniscus. However, the recent interpretation of the ramp lesions, their causation, anatomical studies, and histologic studies has uncovered a different dimension to these lesions. With recent knowledge of anatomy and soft-tissue attachments around the posterior horn of the medial meniscus, the attachments of the articular capsule, posteromedial capsule, meniscocapsular ligament, meniscotibial ligament, and semimembranosus, there is a need to understand these injuries differently. Because the anatomical structures injured during the ramp lesion will decide the treatment strategy to repair it anatomically, a review of the classification and repair techniques is necessary. The existing classification is descriptive and does not suggest a repair strategy for each classification. Because the ramp lesion, by definition, does not affect the meniscus tissue, it is a peel-off injury of the posteromedial structures. Hence, injury to the meniscus without injury to the meniscocapsular ligament, or meniscotibial ligament, cannot be classified as a ramp lesion. This article proposes an arthroscopic and functional classification.
| S-EPMC11873475 | biostudies-literature
Project description:Meniscus root tears are tears that occur within 1 cm of the meniscus root attachment to the tibia. If not repaired, root tears will lead to altered knee biomechanics and accelerated degenerative changes in the knee. In this surgical technique, we demonstrate repair of a meniscus root tear with an all-inside suture repair of the posterior meniscus that is then passed through 2 transtibial tunnels and then fixed with an anchor. After surgery, patients are non-weightbearing for 4 weeks and can return to activity by 6 months.
| S-EPMC10390842 | biostudies-literature
Project description:Ramp injury, that is, injury to the peripheral attachment of the posterior horn of the medial meniscus, often requires additional surgery during anterior cruciate ligament (ACL) reconstruction. Diagnosis and treatment of ramp lesions are important because unrepaired ramp lesions could cause risk to the reconstructed ACL because of anteroposterior and external rotation laxity, whereas acute rupture or chronic deficiency of the ACL could also cause ramp lesions because of instability. Ramp lesions are difficult to diagnose and treat from the anterior compartment during arthroscopy. Typically, this repair requires technically demanding skills and is performed from the posterior portal using a suture hook under visualization with the arthroscope through the intercondylar notch. Inexperienced surgeons often struggle with using the posterior portal and the suture hook. Our all-inside repair technique using the FasT-Fix system (Smith & Nephew, Andover, MA) under direct visualization from the anterior compartment accompanied by a medial collateral ligament pie-crusting technique facilitates repair of ramp lesions without causing medial instability.
| S-EPMC8085387 | biostudies-literature
Project description:The clinical importance of meniscal ramp lesions in patients with anterior cruciate ligament tears has emerged. However, the diagnostic accuracy of magnetic resonance imaging for detecting meniscal ramp lesions is low. The advantage of ultrasonography is that it can be performed in any position and is a real-time imaging modality. The goal of this Technical Note is to describe in detail the ultrasound technique that we use to detect meniscal ramp lesions in patients with anterior cruciate ligament tears. The semimembranosus muscle is a reliable landmark for this technique. The examination position is prone, with the knee joint flexed to 70°. The most important part of this technique is to instruct the patient to perform isometric contractions in knee flexion with the support of an assistant. The presence or absence of a meniscal ramp lesion can be diagnosed preoperatively by setting the probe above the semimembranosus tendon.
| S-EPMC8252820 | biostudies-literature