Clinical Outcomes Following Treatment of Ramp Lesion during Anterior Cruciate Ligament Reconstruction (Systematic Review and Meta-Analysis)

Abstract

Abstract Background Ramp lesion is defined as a vertical longitudinal detatchment of PHMM due to meniscocapsular ligament tears that is not greater than 2 cm in medio-lateral length resulting in separation of meniscocapsular or meniscotibial ligament. Aim of the Work The study aims to perform a systemic review and meta analysis concerning outcomes of ramp lesion repair during ACL reconstruction. Methodology Systematic review and Meta-analysis on Patients with ramp lesion undergoing ACL reconstruction and ramp lesion treatment with total of 387 studies matched our search terms. After exclusion of duplicates, 37 studies were initially included based on their Abstract. 27 studies were finally included. The average MINORS score of all non-randomised studies was 8.7/16 for non- comparative studies and 16.9/24 for comparative studies, respectively. Results Our results suggest that medial meniscus repair associated with ACL reconstruction may restore meniscal function by adjusting the anteroposterior length of the torn medial meniscus. Our data demonstrate that more than 75% of medial meniscal tears in the ACL-deficient knee occur in the peripheral posterior horn. If we assume that the anatomy as described by Hughston and Eilers is correct, then care should be taken when addressing these tears, because a strong repair is needed to preserve the stability of the knee. Conclusion MRI demonstrated moderate sensitivity and excellent specificity in the diagnosis of ramp lesion in patients with ACL tear. According to the current systematic review, ramp lesions are common in ACL-deficient knees and are often missed through standard anterior portals. Exploration of the meniscocapsular complex via an additional posteromedial portal is recommended, if MRI suggests a lesion in this area or if instability is present at probing. If the posteromedial view still does not reveal any lesion despite significant instability, soft-tissue debridement might uncover hidden lesions (meniscotibial ligament disruptions). Ramp lesion repair leads to a significant improvement of subjective knee scores, regardless of the specific fixation technique. For stable ramp lesions, trephination and abrasion might be equivalent to ramp lesion repair in terms of postoperative stability.