Summary

Using an arthroscopic hook through a posteromedial portal to repair a ramp lesion is not sufficient to restore completely the anatomy of the ramp

Abstract

Purpose

to evaluate the ability to repair anatomically a ramp lesion using 2 different surgical techniques: a surgical hook through the posteromedial portal or all-inside devices from the antemedial portal.

Method

Thirty-five cryopreserved cadaveric knees underwent to arthroscopic evaluation. Five knees were excluded because they presented structural alterations in the medial meniscus or advanced medial compartment osteoarthritis. 30 knees were included in the study, a complete ramp tear was created using a trans-notch view and an arthroscopic scalpel from the posteromedial portal. Knees were randomized into 3 treatment: 1) arthroscopic hook suture from the posteromedial portal, 2) all-inside suture from the anteromedial portal, or 3) combined suture with both techniques. Two experienced knee surgeons performed the meniscal repairs randomizing the 3 treatments. At the end of the repair, the knees were dissected by an anatomist experienced in anatomical knee dissection, assisted by a knee surgery fellow. Both were blinded to the type of suture performed. During the dissection, the status of the repair of both the menisco-tibial portion of the ramp and the menisco-capsular portion of the ramp were assessed. The ramp lesion was divided into 4 quarters and the repair was assessed as: PRESENT when the lesion was repaired for more than 75% of its length, PARTIAL when the repaired tissue was between 25 and 75% and ABSENT when less than 25% of the tissue was included in the repair.

Results

Group 1: the menisco-capsular component suture was PRESENT in 100% of the cases. The menisco-tibial component suture was ABSENT in 80% and PARTIAL in 20% of the cases.
Group 2: the menisco-capsular component suture was PRESENT in 70%, PARTIAL in 20% and ABSENT in 10% of the cases. The menisco-tibial component suture was PRESENT in 100% of the cases.
Group 3: both the menisco-capsular component and the menisco-tibial component suture were PRESENT in 100% of the cases (p<0.001)

Conclusions

suturing a ramp lesion in a cadaveric model with a surgical hook from the posteromedial portal, it is not possible to restore the correct anatomy of the ramp in most of the cases. According to the results of the present study, the recommended technique for an anatomical suture of all components of the ramp is a combined suture from the posteromedial and anteromedial portal. The suture from the anteromedial portal alone achieves consistently the repair of the menisco-tibial components and in more than 70% of the cases of the menisco-capsular components.