Abstract
Meniscal tear patterns associated with anterior cruciate ligament (ACL) tears, such
as root tears and ramp lesions are common but less easily recognized on magnetic resonance
imaging (MRI) compared with a complete radial tear or a locked bucket-handle tear.
Timely treatment of these tears improves outcomes in the setting of ACL reconstruction.
While physical examination does not enable a definitive diagnosis of meniscal root
tears and ramp lesions, high-grade laxity, including a 3+ Lachman and 3+ pivot shift,
should raise suspicions for these tear patterns. MRI allows visualization of both
root tears and ramp lesions, although the gold standard for diagnosis is probing at
the time of arthroscopy due to a high false-negative rate on MRI. Up to 17% of patients
with an ACL tear have a lateral meniscal root tear; a contact mechanism and increased
posterior slope are both associated with a greater incidence of lateral meniscal root
tears and these are repaired with a tunnel technique. Meniscal ramp lesions occur
in up to 41% of patients with ACL tears due to a contact mechanism, and we prefer
repair with an inside-out technique. More than 60% of complete radial meniscal tears
occur in the setting of ACL tears and are preferentially repaired with a hashtag technique
for minimally separated tears and a 2-tunnel technique combined with an inside-out
repair for more severe tears. Bucket-handle tears are more common in the setting of
chronic ACL deficiency; concurrent with ACL reconstruction urgent meniscal repair
with an inside-out technique is the gold standard, which allows for precise approximation
of the tear with multiple points of fixation for improved biomechanical performance.
It is critical to identify and treat these tears during ACL reconstruction because
of their role as secondary stabilizers and for long-term chondral protection.
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Bibliography
- Posteromedial meniscocapsular injury associated with rupture of the anterior cruciate ligament: A previously unrecognised association.J Bone Joint Surg Br. 2010; 92: 222-223
- Meniscal ramp lesions: Anatomy, incidence, diagnosis, and treatment.Orthop J Sports Med. 2016; 4 (2325967116657815)
- Two-tunnel transtibial repair of radial meniscus tears produces comparable results to inside-out repair of vertical meniscus tears.Am J Sports Med. 2017; 45: 2253-2259
- Incidence and detection of meniscal ramp lesions on magnetic resonance imaging in patients with anterior cruciate ligament reconstruction.Am J Sports Med. 2017; 45: 2233-2237
- Inside-out repair of meniscal ramp lesions.Arthrosc Tech. 2017; 6: e1315-e1320
- Clinical characteristics and outcomes after primary ACL reconstruction and meniscus ramp repair.Orthop J Sports Med. 2020; 8 (2325967120912427)
- Quantitative and qualitative assessment of the posterior medial meniscus anatomy: Defining meniscal ramp lesions.Am J Sports Med. 2019; 47: 372-378
- Lateral meniscus posterior root and meniscofemoral ligaments as stabilizing structures in the ACL-deficient knee: A biomechanical study.Orthop J Sports Med. 2017; 5 (2325967117695756)
- Risk factors for ramp lesions of the medial meniscus: A systematic review and meta-analysis.Am J Sports Med. 2021; 49: 3749-3757
- A modified transtibial pull-out repair for posterior root avulsions of the lateral meniscus with concomitant anterior cruciate ligament reconstruction: A Report of two cases.JBJS Case Connect. 2014; 4: e96
- Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs.J Bone Joint Surg Am. 2014; 96: 471-479
- Meniscal root tears: Solving the silent epidemic.J Arthrosc Surg Sports Med. 2021; 2: 47-57
- Arthroscopic prevalence of ramp lesion in 868 patients with anterior cruciate ligament injury.Am J Sports Med. 2011; 39: 832-837
- Medial meniscus ramp and lateral meniscus posterior root lesions are present in more than a third of primary and revision ACL reconstructions.Knee Surg Sports Traumatol Arthrosc. 2021; 29: 3059-3067
- 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: 1080-1085
- Epidemiological evaluation of meniscal ramp lesions in 3214 anterior cruciate ligament-injured knees from the SANTI study group database: A risk factor analysis and study of secondary meniscectomy rates following 769 ramp repairs.Am J Sports Med. 2018; 46: 3189-3197
Article Info
Footnotes
The authors report the following potential conflicts of interest or sources of funding: R.F.L. reports personal fees from Arthrex, grants and personal fees from Ossur, grants and personal fees from Smith & Nephew, and personal fees from Linvatec, outside the submitted work; editorial boards for American Orthopaedic Society for Sports Medicine (AOSSM), Journal of Experimental Orthopaedics, Knee Surgery, Sports Traumatology, Arthroscopy; and committees of AOSSM, AANA, and International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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