scholarly journals “Ramp lesions” of the posterior segment of the medial meniscus: what is repaired? An anatomical and histological study

2020 ◽  
Vol 8 (2_suppl) ◽  
pp. 2325967120S0001
Author(s):  
Quentin Nicolas ◽  
Rémi Di Francia ◽  
Goulven Le Henaff ◽  
Isabelle Quintin-Roue ◽  
François-Xavier Gunepin ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Histological Study ◽  
Cruciate Ligament ◽  
Attachment Site ◽  
Posterior Segment ◽  
Ligament Injury ◽  
Ramp Lesion ◽  
Parallel Network ◽  
Anterior Cruciate ◽  
Posteromedial Capsule

Background: Lesions of the posterior segment of the medial meniscus are the most common intra-articular lesions associated with anterior cruciate ligament injury. “Ramp lesions” have been defined as a tear in the peripheral attachment of the posterior horn of the medial meniscus (PHMM). These injuries are difficult to detect on preoperative MRI, whereas their prevalence with arthroscopy can be as high as 24%. The management of “Ramp lesions” isn’t collegiale. There are only two publications in PUBMED concerning anatomic and histological description posterior menisco-tibial ligament ( PMTL). The objective of this histological study was to analyze the posterior segment of the medial meniscus and its meniscosynovial junction, in order to identify the PMTL. Methods: We dissected ten cadaveric knees. A posterior approach to the posteromedial capsule was used. Therefore, we were able to access the posterior segment of the medial meniscus and its meniscosynovial junction. The proximal capsule, the posterior segment of the medial meniscus, the entire meniscal capsular-tibial junction, and a fragment of the tibia were removed together. For each part, three section slices were prepared for the histological study. Results: Macroscopically, the meniscotibial attachments was pellucid, homogeneous. The meniscocapsular attachments was pellucid, homogeneous but appeared to be strengthened at both the anterior and posterior portions of the capsule. The microscopic study of meniscosynovial jonction revealed loose collagen fibers, oriented but not organized parallel, network with rare fibroblasts and and adipocytes, several capillaries were seen. No histological differences were observed, and the 2 attachments merged at a common attachment site on PHMM. Conclusion: For us, “Ramp lesion” is a tear of common attachment of menicocapsular and meniscotibial junctions of PHMM. This attachment is vascularized, an outfit is possible and biomechanical role is increasingly identified.

scholarly journals Ramp lesion of the medial meniscus

2021 ◽  
Vol 6 (5) ◽  
pp. 372-379
Author(s):  
Yusuf Omar Qalib ◽  
Yicun Tang ◽  
Dawei Wang ◽  
Baizhou Xing ◽  
Xingming Xu ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Injury ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Treatment Options ◽  
Ligament Injury ◽  
Ramp Lesion ◽  
Male Sex ◽  
Anterior Cruciate ◽  
Time From Injury

Ramp lesion of the medial meniscus used to be completely disregarded in the past. Ramp lesion has been now put under the spotlight by orthopaedic and sport medicine surgeons and requires attention. It is closely associated with anterior cruciate ligament injury. Major risk factors include chronic laxity, lateral meniscal lesion, anterior cruciate ligament reconstruction revision, anterolateral ligament tear concomitant with anterior cruciate ligament injury, time from injury, pre-operative side-to-side laxity > 6 mm, age < 30 years old, male sex, etc. Radiologists attempt to create diagnostic criteria for ramp lesion using magnetic resonance imaging. However, the only definite method to diagnose ramp lesion is still arthroscopy. Various techniques exist, among which posteromedial approach is the most highly recommended. Various treatment options are available. The success rate of ramp repair is very high. Major complications are uncommon. Cite this article: EFORT Open Rev 2021;6:372-379. DOI: 10.1302/2058-5241.6.200126

The effect of unloader knee braces on medial meniscal strain

2018 ◽  
Vol 43 (2) ◽  
pp. 132-139 ◽  
Author(s):  
Mayank Kalra ◽  
Ryan Bakker ◽  
Sebastian S Tomescu ◽  
Anna M Polak ◽  
Micah Nicholls ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Injury Risk ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Compressive Force ◽  
Ligament Injury ◽  
Knee Braces ◽  
Anterior Cruciate

Background: A medial meniscal tear is a common knee injury, especially following an anterior cruciate ligament injury. Decreasing the compressive force on the medial meniscus during dynamic activities using an unloader knee brace could reduce meniscal strain, effectively reducing injury risk and/or severity. Objectives: To investigate the efficacy of two unloader knee braces on medial meniscus strain during dynamic activities in intact & deficient anterior cruciate ligament states. Study design: Combined in vivo/in vitro study. Methods: In vivo knee kinematics and muscle force profiles from a healthy individual performing single/doubleleg squats and walking motions were simulated on 10 cadaveric specimens using a dynamic knee simulator system. Simulations were performed on knees in unbraced and braced scenarios, with and without the anterior cruciate ligament. Anterior and posterior medial meniscal strains were measured. Results: Two different braces each showed a significant reduction in the posteromedial meniscal strain ( p ⩽ 0.01) in an intact anterior cruciate ligament state. Neither brace mirrored this result for the anteromedial strain ( p > 0.05). In the deficient anterior cruciate ligament state, the braces had no significant effect on strain ( p > 0.05). Conclusion: Two unloader knee braces effectively reduced strain in the medial meniscus with an intact anterior cruciate ligament during dynamic activities. Neither brace made a significant reduction in strain for anterior cruciate ligament-deficient knees. Clinical relevance Unloader knee braces could be used to reduce the medial meniscus strain following meniscal surgery and during rehabilitation in patients with an isolated medial meniscus injury. However, these braces cannot be recommended for this purpose in patients with an anterior cruciate ligament deficiency.

The effect of a longitudinal tear of the medial meniscus on medial meniscal extrusion in anterior cruciate ligament injury patients

The Knee ◽  
2019 ◽  
Vol 26 (6) ◽  
pp. 1292-1298
Author(s):  
Hiroki Katagiri ◽  
Kazumasa Miyatake ◽  
Yusuke Nakagawa ◽  
Koji Otabe ◽  
Toshiyuki Ohara ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Injury ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Meniscal Extrusion ◽  
Anterior Cruciate ◽  
Longitudinal Tear

Analysis of Risk Factors for Ramp Lesions Associated With Anterior Cruciate Ligament Injury

2020 ◽  
Vol 48 (7) ◽  
pp. 1673-1681
Author(s):  
Seong Hwan Kim ◽  
Hyun Je Seo ◽  
Dong Won Seo ◽  
Kang-Il Kim ◽  
Sang Hak Lee
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Significant Risk ◽  
Area Under The Curve ◽  
Tibial Slope ◽  
Ligament Injury ◽  
Ramp Lesion ◽  
Bone Contusion ◽  
Anterior Cruciate

Background: The incidence of meniscocapsular junction tears of the medial meniscus posterior horn, known as ramp lesions, is reported to be 9.3% to 23.9%. However, these lesions are not consistently diagnosed with routine arthroscopic exploration and magnetic resonance imaging (MRI). Purpose: To determine risk factors associated with ramp lesions in anterior cruciate ligament–injured knees. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 275 patients undergoing anterior cruciate ligament reconstruction between June 2011 and March 2019 were included in this study. Exclusion criteria were revisions, fracture histories, and multiple-ligament injuries other than medial collateral ligament injury. Patients were divided into 2 groups, those with and without ramp lesions according to arthroscopic diagnosis. Binary logistic regression was used to analyze risk factors: age, sex, body mass index, time from injury to surgery (<3 or ≥3 months), mechanism of injury (contact/noncontact), Segond fracture, side-to-side laxity, location of bone contusion, medial and lateral tibial/meniscal slope, and mechanical axis angle. Receiver operating characteristic curves and area under the curve were evaluated. A prediction model was developed by multivariable regression with generalized estimating equations. Results: Overall, 95 patients (34.5%) were confirmed as having a ramp lesion. The sensitivity of MRI for ramp lesions was 85.3%, and specificity was 78.3%. Significant risk factors for ramp lesion were as follows: posterior medial tibial plateau bone contusion on MRI (odds ratio [OR], 4.201; 95% CI, 2.081-8.482; P < .001), ≥3 months from injury (OR, 4.818; 95% CI, 2.158-10.757; P < .001), varus knee >3° (OR, 2.339; 95% CI, 1.048-5.217; P = .038), steeper medial tibial slope (OR, 1.289; 95% CI, 1.002-1.66; P = .049) and meniscal slope (OR, 1.464; 95% CI, 1.137-1.884; P = .003), and gradual lateral tibial slope (OR, 0.775; 95% CI, 0.657-0.914; P = .002). The area under the curve for the prediction model developed by logistic regression was 0.779 (sensitivity, 75.8%; specificity, 71.7%; P < .001) for ramp lesions. Conclusion: Care should be taken with patients who have significant risk factors for ramp lesions, including bone contusion at the posterior medial tibial plateau, chronic injury, steeper medial tibial and meniscal slope, gradual lateral tibial slope, and varus knee >3°.

Anterior cruciate ligament injury risk factors in football

2019 ◽  
Vol 59 (10) ◽  
Author(s):  
Gian Nicola Bisciotti ◽  
Karim Chamari ◽  
Emanuele Cena ◽  
Andrea Bisciotti ◽  
Alessandro Bisciotti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Injury ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Ligament Injury ◽  
Injury Risk Factors ◽  
Anterior Cruciate
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