Summary

The posteromedial approach and assessment of the medial meniscus should be performed routinely during ACL reconstruction, as it has greater potential in visualization of Ramp lesions.

Abstract

Introduction

Ramp lesion injuries of the medial meniscus quite often accompany ACL injuries. The MRI image may be false negative in such cases. Overlooking and not repairing this damage may negatively affect the final result of the ACL reconstruction. Many authors recommend a routine posteromedial approach during ACL reconstruction.

Material&Method: In the years 2021-2023, we routinely performed posteromedial portal to the knee joint during ACL reconstruction to inspect the joint for concomitant Ramp lesion in 100 patients. The decision to operate was undertaken on the basis of MRI examination of the joint. After the procedure we reanalyzed the MRI images of patients who had "ramp lesion" at arthroscopy.

Results

We found 20 undiagnosed Ramp lesion at the time of the surgery decision making, meaning that 20% of Ramp lesions were uncovered during the arthroscopy. After the surgery, during second MRI analysis, in 6 out of 20 cases, the lesion was invisible in MRI, which means that the sensitivity of this examination in the case of "ramp lesion" is about 65% (14/20).

Conclusions

The posteromedial approach and assessment of the medial meniscus should be performed routinely during ACL reconstruction, as it has greater potential in visualization of Ramp lesions.