scholarly journals Bony injury associated with ramp lesion and a double meniscal injury – A hidden terrible triad of the posteromedial knee

2021 ◽  
Vol 16 ◽  
pp. 264-268
Author(s):  
Srinivas B.S. Kambhampati ◽  
Sai Prasad Chittoor ◽  
Suryanarayana Rao Akella
Keyword(s):  
Meniscal Injury ◽  
Terrible Triad ◽  
Ramp Lesion ◽  
Bony Injury

Terrible Triad Injury or Complicated Triad Injury of Elbow: A Systematic Review

2020 ◽  
Vol 03 (03) ◽  
Author(s):  
Weijun Guo ◽  
Di Lu ◽  
Jiqi Wang ◽  
Peng Luo ◽  
Miao Liu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Terrible Triad

scholarly journals DELAY TO ACL RECONSTRUCTION IN PEDIATRIC AND ADOLESCENT PATIENTS IS ASSOCIATED WITH A LINEAR INCREASE IN THE RISK OF MEDIAL MENISCAL TEARS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
David A. Kolin ◽  
Brody Dawkins ◽  
Joshua Park ◽  
Peter D. Fabricant ◽  
Allison Gilmore ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Linear Increase ◽  
Meniscal Injury ◽  
Meniscal Tears ◽  
Increased Risk ◽  
Text Figure ◽  
Time From Injury

Background: Anterior cruciate ligament (ACL) tears are frequently associated with meniscal tears. Previous studies have shown that secondary meniscal tears—occurring after the initial ACL injury—are associated with greater delays from injury to ACL reconstruction (ACLR), but frequently use dichotomous categories of acute versus delayed ACLR. Purpose: As meniscal damage is likely accrued constantly over time, we investigated the variability of concurrent meniscal injuries as a function of time from injury to ACLR in a pediatric and adolescent population. Methods: We performed a retrospective review of all patients ≤18 years who underwent an ACLR between 2014 and 2018 at one of two tertiary academic hospitals. Outliers were excluded if time from injury to ACLR was greater than 78 weeks. Records were reviewed to assess patients’ dates of injury and surgery. The prevalence of concurrent medial and/or lateral meniscal injury was evaluated at the time of surgery for each patient. Adjusted relative risks (ARRs) of meniscal injury were calculated using Poisson regression models adjusted for age, sex, and body-mass index. Logistic regression was used to model the predicted probability of medial meniscal tears. Results: 546 patients met inclusion criteria. The mean age of participants was 15.3 years (S.D., 1.6), and 277 (50.7%) patients were male. Overall, 344 (63.0%) patients had a meniscal tear. 169 (49.1%) tears occurred at the medial meniscus, and 257 (74.7%) occurred at the lateral meniscus (Table 1). Compared to females, males had a greater risk of lateral meniscal injury (ARR, 1.46; 95% CI, 1.20-1.77) but not medial meniscal injury (ARR, 1.01; 95% CI, 0.77-1.31) (Figure 1). When considering all meniscal tears, time from injury to ACLR was not associated with increased risk of a tear (ARR, 1.01; 95% CI, 1.00-1.01). However, for medial meniscal tears, there was a significant association between time from injury to ACLR, in weeks, and meniscal tears (ARR, 1.02; 95% CI, 1.01-1.03, P = 0.003). A ten-week delay was associated with a 20% increased risk of medial meniscal injury (Figure 2). Conclusion: In pediatric and adolescent ACLR patients, the risk of any meniscal injury was not associated with delay from injury to surgery. However, the risk of medial meniscal injury increased by 2% each week from injury to surgery. [Table: see text][Figure: see text][Figure: see text]

Mechanism of Injury in Ramp Lesion: Letter to the Editor

2021 ◽  
Vol 49 (9) ◽  
pp. NP49-NP49
Author(s):  
Srinivas B.S. Kambhampati ◽  
Raju Vaishya
Keyword(s):  
Mechanism Of Injury ◽  
Letter To The Editor ◽  
Ramp Lesion

Graft Failure, Revision ACLR, and Reoperation Rates After ACLR With Quadriceps Tendon Versus Hamstring Tendon Autografts: A Registry Study With Review of 475 Patients

2021 ◽  
pp. 036354652110151
Author(s):  
Malte Schmücker ◽  
Jørgen Haraszuk ◽  
Per Hölmich ◽  
Kristoffer W. Barfod
Keyword(s):  
Graft Failure ◽  
Ligament Reconstruction ◽  
Pivot Shift ◽  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Significant Trend ◽  
Meniscal Injury ◽  
Registry Study ◽  
Cyclops Lesion

Background: It has been indicated that anterior cruciate ligament reconstruction (ACLR) with a quadriceps tendon (QT) graft has a higher risk of revision compared with ACLR performed with a hamstring tendon (HT) graft. Purpose/Hypothesis: To investigate whether ACLR with QT graft had a higher risk of graft failure, revision ACLR, or reoperation compared with HT graft in a high-volume center. We hypothesized that there would be no between-group differences. Study Design: Cohort study; Level of evidence, 3. Methods: This was a registry study with review of medical records. Our study cohort consisted of patients who underwent primary ACLR with either QT or HT graft performed at Copenhagen University Hospital Hvidovre between January 2015 and December 2018. The cohort was identified from the Danish Knee Ligament Reconstruction Registry and linked to the Danish National Patient Registry to identify all hospital contacts after ACLR. The outcome variables were graft failure (rerupture or >3-mm side-to-side difference in anteroposterior [AP] laxity), revision ACLR, reoperation due to cyclops lesion, reoperation due to meniscal injury, and reoperation due to any reason. AP laxity and pivot shift were assessed at 1 year. Kaplan-Meier estimates were used to evaluate the rates of events at 2 years, and comparison was performed with Cox regression analysis. Results: A total of 475 patients (252 HT, 223 QT) were included. The rate of graft failure at 2 years was 9.4% for the QT group and 11.1% for the HT group ( P = .46). For the QT and HT groups, respectively, the rate of revision ACLR was 2.3% and 1.6% ( P = .60), the rate of reoperation due to cyclops lesion was 5.0% and 2.4% ( P = .13), and the rate of reoperation due to meniscal injury was 4.3% and 7.1% ( P = .16). The rate of reoperation due to any reason was 20.5% and 23.6% ( P = .37). At 1-year follow-up, AP laxity was 1.4 mm for QT and 1.5 mm for HT ( P = .51), and the proportion of patients with a positive pivot shift was 29-30% for both groups. Conclusion: QT and HT grafts yielded similar rates of graft failure, revision ACLR, and reoperation at 2 years of follow-up after ACLR. Graft failure was found in 9% to 11% of patients. Patients with QT ACLR showed a non–statistically significant trend of higher risk for reoperation due to cyclops lesion, and those with HT showed a non–statistically significant trend of higher risk for reoperation due to meniscal injury.

scholarly journals A rare combination of fractures around the elbow: Bony variant of terrible triad

2015 ◽  
Vol 18 (6) ◽  
pp. 363-366
Author(s):  
Vishal Kumar ◽  
Avinash Kumar ◽  
Sameer Aggarwal
Keyword(s):  
Terrible Triad ◽  
Rare Combination

scholarly journals Is Edema at the Posterior Medial Tibial Plateau Indicative of Ramp Lesion? An Examination of 852 Patients with Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0013
Author(s):  
Neil Kumar ◽  
Tiahna Spencer ◽  
Edward Hochman ◽  
Mark P. Cote ◽  
Robert A. Arciero ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Mechanism Of Injury ◽  
Medial Tibial Plateau ◽  
Meniscal Tears ◽  
Ramp Lesion ◽  
Anterior Cruciate ◽  
Operative Notes

Objectives: Meniscal injuries are commonly observed with anterior cruciate ligament (ACL) deficiency. A subset of these injuries includes tears of the medial meniscus at the posterior meniscocapsular junction, or ramp lesions. Biomechanical studies have indicated that ramp injuries may compromise anterior stability of the knee, even after ACL reconstruction (ACLR). These lesions are not consistently diagnosed with magnetic resonance imaging (MRI). One criterion that shows promise is the presence of posterior medial tibial plateau (PMTP) edema. A correlation of PMTP edema and peripheral posterior horn medial meniscal injuries has been observed in the literature. We evaluated a consecutive series of patients who underwent ACLR for incidence of ramp tears. These patients were then compared to patients with non-ramp (meniscal body) medial meniscal tears. The utility of PMTP edema on preoperative MRI for ramp tear diagnosis was then determined. Methods: A retrospective chart review via an institutional database search identified 892 patients who underwent ACLR by one of two senior authors (R.A.A., C.E.) between January 2006 and June 2016. Operative notes identified patients diagnosed arthroscopically with medial meniscal lesions, including ramp lesions. Arthroscopic identification was the gold standard for diagnosis of both ramp and non-ramp (meniscal body) tears. Demographic information such as age, sex, laterality, mechanism of injury (contact/noncontact), sport, revision procedure, multi-ligament procedure, time to MRI, and time to surgery were recorded. Patients without available operative records were excluded. Preoperative MRIs were obtained for all patients and reviewed by an orthopaedic sports medicine fellow for PMTP edema. Axial, coronal, and sagittal T2 and proton-density sequences were utilized. A MRI was considered positive if edema was detected in 2 different planes of sequences. Differences between groups were analyzed with two-sample t test or Chi square test Univariate and multivariate logistic regression models analyzed the relationships among patient factors, MRI findings, and ramp lesions. Results: 852 patients met the inclusion criteria for analysis. 307 patients were diagnosed with medial meniscal tear at the time of ACLR, 127 of which were ramp lesions. The overall incidence of ramp tear was 14.9% and consisted of 41.4% of all medial meniscal tears. Patients with ramp tears were mean 7.5 years younger than patients with meniscal body tears ( p<0.01). There was no difference between the groups in regard to mechanism of injury, revision surgery, or multi-ligamentous injury. Patients with delayed ACLR were at 3.3x greater odds ( p<0.01) of having meniscal body tear compared to ramp lesion. MRI was available for review in 178 patients, 97 of whom had positive MRI for PMTP edema. Sensitivity and specificity of PMTP edema for ramp tear was 66.3% and 55.1%, respectively. Of patients with PMTP edema, 54.6% had ramp lesions and 45.4% had non-ramp tears ( p<0.01). Patients with preoperative MRI positive for PMTP edema were at 2.1 times greater odds ( p<0.01) of having sustained a ramp tear compared to a meniscal body tear. Conclusion: The incidence of ramp tear was 14.9% and was more prevalent in younger patients. Delayed ACLR resulted in 3.3x greater odds of meniscal body tears compared to ramp tears. Patients with PMTP edema on preoperative MRI were at 2.1x greater odds to have ramp lesions compared to a meniscal body tears at the time of ACL reconstruction.

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