2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Incidence and Treatment Strategy for Posterior Lateral Meniscus Root Tears and Ramp Lesions and in a Nation – Data from the Norwegian Knee Ligament Register

Havard Visnes, MD, PT, PhD, Kristiansand NORWAY
Andreas Persson, MD, Oslo NORWAY
Anne Marie Fenstad, MSc, Bergen NORWAY
Eivind Inderhaug, MD, PhD, MPH, Bergen NORWAY

The Norwegian Knee Ligament Register, Bergen, NORWAY

FDA Status Not Applicable

Summary

The incidence of concomitant posterior lateral meniscus root tears (PLMRT) and ramp lesions during primary ACL reconstructions in Norway was recorded at 10.0% and 7.8%. The primary treatment for PLMRT was transtibial suture with cortical fixation. In contrast, ramp lesions exhibited a more varied approach, with treatment strategies divided between "all-inside" and alternative suturing method.

Abstract

Introduction

Meniscus repair in combination with Anterior Cruciate Ligament reconstruction (ACLR) has significantly increased in Norway over the past 15 years. This trend may be driven by the increased focus on Posterior Lateral Meniscus Root Tear (PLMRT) and ramp lesions. These tear types have been reported to the Norwegian National Knee Ligament Register (NKLR) since 2018.

Aim

To define the incidence and treatment strategies of PLMRT and ramp lesions in primary ACLR in Norway.

Method

Data were included from patients with primary ACLR electronically registered in the NKLR from 2018 to 2023. Preoperative patient-reported data were recorded. The occurrence of concomitant meniscal lesions, as well as the specific types of lesions, has been documented to vary based on patient-related factors and the activities engaged in at the time of injury.

Results

A total of 5,309 ACLR were included, with 68% associated meniscal injuries. PLMRT and ramp lesions were identified in 10.0% and 7.8% of % of the patient cohort, respectively. A combination of both injuries was present in 1.1% of patients. The incidence of meniscal injuries was notably higher in males compared to females (43.8% versus 56%, p=0.001), with a significant correlation observed between higher body weight in males and an increased risk of meniscal injuries (weight: 83.7 ± 14.1 kg versus 81.9 ± 13.5 kg, p=0.003. Patients presenting with ramp lesions were significantly younger than those without meniscal injuries (age: 25.3 ± 8.9 years versus 28.5 ± 10.8 years, p=0.001) and also younger compared to the PLMRT group (age: 29.4 ± 10.6 years, p=0.001). Furthermore, individuals with meniscal injuries exhibited lower preoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) across all subscales (p=0.001), with the exception of those with ramp lesions, whose scores did not significantly differ from those without meniscal injuries. Soccer was identified as the most prevalent activity at the time of injury, accounting for 36.4% (n=1,932) of cases, with 9.9% of these involving ramp lesions and 10.7% involving PLMRT. Conversely, winter sports, including skiing, snowboarding, and alpine skiing, exhibited the highest incidence rates for both ramp lesions (14.2%) and PLMRT (14.3%).
The predominant treatment approach for PLMRT involved transtibial suture with cortical fixation. In the case of ramp lesions, the treatment strategies were divided between an "all-inside" technique (n=313) and various "other suturing" techniques (n=108). On average, three sutures were utilized per repair procedure.

Conclusion

The incidence of concomitant posterior lateral meniscus root tears (PLMRT) and ramp lesions during primary ACL reconstructions in Norway was recorded at 10.0% and 7.8%, respectively. The primary treatment modality employed for PLMRT involved the use of transtibial suture with cortical fixation. In contrast, the management of ramp lesions exhibited a more varied approach, with treatment strategies divided between "all-inside" suturing techniques and alternative suturing methods.