2021 ISAKOS Biennial Congress ePoster
Anticipate, explore and repair : ACL injury associated ramp lesions
Sumit Banerjee, MS (Orth), MCh(Orth), Jodhpur, Rajasthan INDIA
Kishore Munde, MS (Orth), Jodhpur INDIA
Suvinay Saxena, MD , Jodhpur, Rajasthan INDIA
All India Institute of Medical Sciences, Jodhpur, Rajasthan, INDIA
FDA Status Cleared
Summary
MRI isn’t reliable in diagnosing Ramp lesions preoperatively. All patients undergoing ACLR must have their posterior compartment visualized and a posteromedial portal is essential to probe and repair Ramp lesions. The presence of mensicotibial ligament separation and length of the lesion can be used as a guide to decide which lesions to repair.
ePosters will be available shortly before Congress
Abstract
Introduction
Meniscocapsular separation or Ramp lesions have been reported to be associated with ACL injuries however, no study has been conducted on an Indian population to find out its incidence and extent.
Aim
This study investigates the incidence of Ramp Lesions in Indian Patients with ACL injury; the extent of lesion and need for repair. We also attempt to assess the sensitivity of MRI in detecting these lesions.
Methods
This study was a prospective case series and all patients undergoing ACL reconstruction over the past one and half year period at the institution were included. The patients’ MRI were evaluated for signs of Ramp lesion. During arthroscopy the posteriomedial compartment was visualized through the standard anterolateral portal using the trans notch maneouver. If a Ramp lesion was identified, a postero medial portal was created to probe the extent of the lesion and if required, repaired with fibre wire suturesusing a suture lasso. A standard operating technique and postoperative rehab protocol was implemented in all the cases of ACLR with or without ramp lesions.
Results
Ramp lesion was identified in 14 patients (12.7%) during diagnostic arthroscopy (n= 110). MRI was only 35 % sensitive in identifying ramp lesions (5/14). 9 of the lesions were associated with separation of the mensicotibial ligament on probing and were repaired using fibre wire sutures. The rest 5 lesions were partial lesions with meniscotibial ligament not completely separated and were stable on probing, these weren’t repaired.
Conclusions
MRI isn’t reliable in diagnosing Ramp lesions preoperatively. All patients undergoing ACLR must have their posterior compartment visualized and a posteromedial portal is essential to probe and repair Ramp lesions. The presence of mensicotibial ligament separation can be used as a guide to decide which lesions to repair.