2025 ISAKOS Biennial Congress ePoster
Needle Assisted All Inside Medial Meniscal Ramp Lesion Repair
Lucas Martorell, MD, Barcelona SPAIN
Simone Perelli, MD,PhD, Barcelona SPAIN
Nicola Pizza, MD SPAIN
Maximiliano Ibañez, MD, Barcelona SPAIN
Àngel Masferrer-Pino, MD PhD, Barcelona SPAIN
Francisco J. Simón-Sánchez, MD SPAIN
Jesus Duenas, Dr SPAIN
Stefano Gaggiotti, MD, Ciudad Autónoma De Buenos Aires, Buenos Aires ARGENTINA
Raúl Torres-Claramunt, PhD, Barcelona SPAIN
Giuseppe Gianluca Costa, MD, Enna ITALY
Joan Carles Monllau, MD, PhD, Prof., Esplugues de Llobregat, Barcelona SPAIN
Institut Català de Traumatologia i Medicina de l'Esport (ICATME)-Hospital Universitari Dexeus,, Barcelona, SPAIN
FDA Status Not Applicable
Summary
This technical note describes a new surgical approach to medial meniscus ramp lesion using a spinal needle from a PM approach to reduce the ramp lesion and all-inside devices deployed from anteromedial portal to effectively repair the damaged structures.
ePosters will be available shortly before Congress
Abstract
Ramp lesions has become a new trending topic in the last years and multiple techniques have been described to address them. Suture hook repair from the posteromedial portal is currently considered as the “gold standard”, but can be technically demanding especially in larger lesions extending in the medial portion of the meniscus.
We aim to present a Technical Note of a new technique for an anatomic repair of both the meniscocapsular and meniscotibial ligaments.
After confirming the ramp lesion by direct visualization the posteromedial portal is made. Without the need for a cannula, a 20 Gauge spinal needle, with the tip previously bended, is placed through the capsular ramp tissue as distal as possible, and then fixed to the posterior horn of the medial meniscus. By doing so, the gap of the tear is reduced, and the MCL and MTL are provisionally brought closer to the posterior wall of the medial meniscus. At that point, the arthroscope is turned back to the anteromedial compartment and the repair is performed using a first all-inside device through the anteromedial portal (the first suture creates an horizontal mattress in the upper surface of the meniscus, providing repair of the MCL). A second all-inside reverse suture is introduced from the same portal inferior to the meniscus (this suture reapproximates the MTL and the meniscal tissue), with the aim of creating a vertical mattress configuration. The stitching procedure may be repeated if the lesion is extended medially always leaving at least 3mm between two stitches to avoid iatrogenic rupture of the meniscal tissue.
The advantages of such technique are multiple: first, it does not need a specific learning curve since it basically consists in a meniscal suture using an all-inside device and it reduces the operative time. This is important advantage given that for not experienced surgeon sometimes is not easy to perform a suture from posteromedial portal. Second, the possibility to be used in more complex lesion such as the ones that involve both MTL and MCL which usually occurs in ACL-deficient knees. Finally, the spinal needle used for temporary reduction and fixation of the lesion can be easily moulded to address any kind of anatomy.