Different Techniques for the Management of Meniscal Ramp Lesions Using Standard Anterior Portals
Publication date: Available online 18 December 2019Source: Arthroscopy TechniquesAuthor(s): Begad Hesham Mostafa Zaky Abdelrazek, Mohammed Refaat Waly, Mahmoud Ahmed Abdel Aziz, Ahmed Abdel AzizAbstractThere is strong association between meniscal lesions and anterior cruciate ligament injuries. Recently, light was shown on a new entity: ramp lesions. The incidence of these lesions and their management is still unclear. Although some believe that some lesions, when stable, can be managed conservatively, most surgeons repair ramp tears. Accessibility of these tears is challenging; they are best accessed through posterior portals, which is time-consuming and poses potential risk to vital structures. Our technique allows access to and management of ramp lesions through safe standard anterior portals. Ramp lesions are searched for as a routine step during anterior cruciate ligament reconstruction by advancing the scope through the intercondylar notch just beside the medial femoral condyle. If a lesion is found, it is repaired; only very stable small tears are treated with needling to refresh the edges and induce a healing response. A simple suture, horizontal mattress suture, or a circumferential stitch is used.
The objective and subjective outcomes at 2 years are presented.MethodsPaediatric patients, less than 16 years of age, presenting acutely with complete proximal ACL ruptures underwent direct arthroscopic ACL repair, reinforced by a temporary internal brace, which was subsequently removed after 3 months. Patient-reported outcome measures including the Lysholm, Tegner and KOOS scores were collected at 6 months, 1 year and 2 years post-operatively.ResultsTwenty patients (age 6 –16) completed data at 2 years post-operatively. There were no failures, no complications and no growth distu...
We describe a technique combining the advantages of both techniques with an autograft using the semitendinosus and repair of the remnant. This combined technique allows protection and redirection of the remnant, improves graft incorporation, and covers more graft by suturing the remnant around an autologous graft.
ConclusionThe progression of post-traumatic chondral damage may occur at a faster rate in patients who require ACL reconstruction and meniscal repair than in patients with intact menisci.
ConclusionThe minimum 5 years survival rate after primary ACL repair using this technique was 70%. This value dropped to 56% in highly active patients performing competitive sports. Patients not suffering failure of repair demonstrated adequate restoration of knee laxity and high satisfaction. This study not only underli nes the potential of ACL repair, but also highlights the danger of the procedure if strict patient selection is not appreciated.Level of evidenceLevel IV.
CONCLUSION: A well-designed database and user-friendly interface have greater potential for research utility, clinical efficiency, and, thus, cost-effectiveness when compared with standard voice-dictated operative notes. Widespread utilization of such tools can accelerate the pace and improve the quality of orthopaedic clinical research. LEVEL OF EVIDENCE: Level IV. PMID: 31977610 [PubMed - in process]
CONCLUSIONS Anterior cruciate ligament suture with the InternalBrace ligament augmentation judging from the results achieved by our group of patients brings very good clinical outcomes already at 6 months postoperatively. This method allows the athletes to return to full load soon. It maintains the kinematics and knee joint proprioception, and thus can potentially contribute to the prevention of post-traumatic arthritis. Strict application of indication criteria is a precondition to success. A longer follow up and evaluation of a larger number of patients will, however, be necessary to definitely confirm the success of thi...
To determine whether subjective knee function or risk of repair failure differ between men and women at mean 5 years following meniscal repair with or without concomitant anterior cruciate ligament reconstruction.
To compare the clinical and magnetic resonance imaging (MRI) outcomes of meniscal repair using absorbable versus nonabsorbable sutures in patients undergoing concomitant anterior cruciate ligament reconstruction.
Publication date: December 2019Source: Arthroscopy Techniques, Volume 8, Issue 12Author(s): Alberto Gobbi, Katarzyna Herman, Radosław Grabowski, Dawid SzwedowskiAbstractIt is well known that the anterior cruciate ligament (ACL) is the main stabilizer to the anterior tibial translation in the knee. The current gold standard of treatment for such lesions is ACL reconstruction. However, there are notable disadvantages to ACL reconstruction that include loss of proprioception, donor site morbidity, incomplete return to high-demand sports, and the inability to restore normal kinematics of the knee joint. Additionally, in adole...
To compare the preoperative and 1- and 2-year postoperative Knee injury and Osteoarthritis Outcome Score (KOOS) subscale scores between isolated anterior cruciate ligament reconstruction (ACLR) and ACLR with additional medial meniscus (MM) and/or lateral meniscus (LM) resection or repair.