Surgical Treatment of Meniscal RAMP Lesion

RAMP lesion, defined as peripheral detachment lesion of posterior horn of medial meniscus, has been shown to accompany anterior cruciate ligament (ACL) ruptures and is thought to play an important role in the knee joint stability. In this study, we aimed to present results of postoperative knee function scores and patient satisfaction after surgical repair of RAMP lesion. We included 15 patients who had undergone knee arthroscopy due to RAMP lesion in 2017. We recorded demographic data, diagnosis, pre- and postoperative International Knee Documentation Committee and Tegner–Lysholm scores of all patients. In this study, we included 15 patients: the number of male and female patients was eight and seven, respectively. The mean age of patients was 26.8 (18–35). Associated injuries included ACL rupture in 12 patients, additional medial meniscus lesion in 3 patients, lateral meniscus lesion in 3 patients, and superomedial patellar plicae syndrome in 2 patients. All patients had the same postoperative rehabilitation protocol. Mean preoperative Tegner–Lysholm knee score was 64.4 (53–75), while it was 82.5 (75–89) postoperatively, and mean preoperative and postoperative Visual Analogue Scale score at last postoperative follow-up were 5.26 (2–8) and 1.06 (0–2), respectively. All differences were found to be statistically significant. Meniscal RAMP lesions are commonly associated with ACL ruptures. RAMP repair significantly increases postoperative knee function scores and patient satisfaction following ACL reconstruction.

High Posterior Tibial Slope Influence Medial Meniscus Injuries in ACL Deficient Knees

The purpose of the current study was to evaluate the correlation between the tibial slope and medial meniscus injury in anterior cruciate ligament deficient knees. A total of 223 patients with primary ACL injury admitted to Foisor Orthopedic Hospital between 2015-2016 were included in this study. The posterior tibial slope was evaluated on a lateral x-ray view of the knee and was defined as the angle between the line joining the tibial plateau and the line perpendicular to the longitudinal axis (the proximal tibial anatomical axis). Patients were divided into two groups depending on the posterior tibial slope ([9.9 and �10), and a Chi square test was used to evaluate if there is any correlation between this and internal meniscus injuries, and Fisher�s exact test was used to verify this. Overall medial meniscus lesions were found in 43.5% of the patients. The mean value of the posterior tibial slope was 11.19+/-2,685. After grouping patients in low and high group ([9.9 and �10), there were 66.8% in the high tibial slope group and 33.2% in the low group. In the high PTS group there were 93 patients with medial meniscus lesion (62.4%), and 56 (37.6%) without medial meniscus lesion. The mean posterior tibial slope was higher in the medial meniscus tear group (11.78 degrees), than mean PTS in the group without medial meniscus lesion (10.42 degrees). There was a strong correlation between high tibial slope and medial meniscus lesions (p=0.015). The main finding of the current study is that there is a statistically significant correlation between posterior tibial slope higher than 10 degrees and internal meniscus tears.

Surgical Management of Degenerative Meniscus Lesions: The 2016 ESSKA Meniscus Consensus

Purpose A degenerative meniscus lesion is a slowly developing process typically involving a horizontal cleavage in a middle-aged or older person. When the knee is symptomatic, arthroscopic partial meniscectomy has been practised for a long time with many case series reporting improved patient outcomes. Since 2002, several randomised clinical trials demonstrated no additional benefit of arthroscopic partial meniscectomy compared to non-operative treatment, sham surgery or sham arthroscopic partial meniscectomy. These results introduced controversy in the medical community and made clinical decision-making challenging in the daily clinical practice. To facilitate the clinical decision-making process, a consensus was developed. This initiative was endorsed by ESSKA. Methods A degenerative meniscus lesion was defined as a lesion occurring without any history of significant acute trauma in a patient older than 35 years. Congenital lesions, traumatic meniscus tears and degenerative lesions occurring in young patients, especially in athletes, were excluded. The project followed the so-called formal consensus process, involving a steering group, a rating group and a peer-review group. A total of 84 surgeons and scientists from 22 European countries were included in the process. Twenty questions, their associated answers and an algorithm based on extensive literature review and clinical expertise, were proposed. Each question and answer set was graded according to the scientific level of the corresponding literature. Results The main finding was that arthroscopic partial meniscectomy should not be proposed as a first line of treatment for degenerative meniscus lesions. Arthroscopic partial meniscectomy should only be considered after a proper standardised clinical and radiological evaluation and when the response to non-operative management has not been satisfactory. Magnetic resonance imaging of the knee is typically not indicated in the first-line work-up, but knee radiography should be used as an imaging tool to support a diagnosis of osteoarthritis or to detect certain rare pathologies, such as tumours or fractures of the knee. Discussion The present work offers a clear framework for the management of degenerative meniscus lesions, with the aim to balance information extracted from the scientific evidence and clinical expertise. Because of biases and weaknesses of the current literature and lack of definition of important criteria such as mechanical symptoms, it cannot be considered as an exact treatment algorithm. It summarises the results of the “ESSKA Meniscus Consensus Project” (http://www.esska.org/education/projects) and is the first official European consensus on this topic. The consensus may be updated and refined as more high-quality evidence emerges. Level of Evidence I.