2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper

 

Repair of Medial Meniscus Ramp Lesion Improves Knee Stability in Anterior Cruciate Ligament Reconstruction: Quantitative Evaluation Using an Electromagnetic Measurement System

Shin Yoshida, MD, Kobe JAPAN
Kanto Nagai, MD, PhD, Kobe, Hyogo JAPAN
Yuta Nakanishi, MD, PhD, Kobe, Hyogo JAPAN
Takeo Tokura, MD, Kobe, Hyogo JAPAN
Yuichi Hoshino, MD, PhD, Kobe, Hyogo JAPAN
Kyohei Nishida , MD, PhD, Kobe, Hyogo JAPAN
Tetsuya Yamamoto, MD, PhD, Kobe, Hyogo JAPAN
Noriyuki Kanzaki, MD, PhD, Kobe, Hyogo JAPAN
Takehiko Matsushita, MD, PhD, Kobe, Hyogo JAPAN
Ryosuke Kuroda, MD, PhD, Kobe, Hyogo JAPAN

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan, Kobe, Hyogo, JAPAN

FDA Status Not Applicable

Summary

This study assessed the impact of medial meniscus ramp lesion repair in ACL reconstruction on postoperative outcomes. Among 127 patients, those with ramp lesions had greater preoperative anterior knee instability but showed comparable stability to controls postoperatively. Ramp lesion repair did not negatively affect outcomes, suggesting it may help restore knee stability in ACL reconstruction.

Abstract

Introduction

Previous studies have suggested that concomitant medial meniscus ramp lesions in anterior cruciate ligament (ACL) injuries are associated with preoperative knee instability. However, there is a lack of studies on the postoperative outcomes. Therefore, purpose of this study is to evaluate the impact of ramp lesion repair in primary ACL reconstruction on postoperative outcomes.

Methods

The present retrospective study included 127 patients who underwent primary ACL reconstruction and second-look arthroscopy one year postoperatively. At the time of primary ACL reconstruction, a definitive diagnosis was made regarding the presence of concomitant meniscal injuries. Ramp group consisted of patients with ramp lesions, while Control group was defined as the patients without medial/lateral meniscal injuries. Preoperatively, under general anesthesia, anterior tibial translation (ATT) during the Lachman test and posterior tibial acceleration during the pivot-shift test were measured using an electromagnetic measurement system (EMS) as previously reported. ATT was also measured using a KT-2000 arthrometer. These measurements were repeated under general anesthesia one year after ACL reconstruction. The preoperative and postoperative side-to-side differences (SSD) of ATT and tibial acceleration were compared between the Control group and the Ramp group using an unpaired t-test (P < 0.05). Preoperative and postoperative International Knee Documentation Committee subjective knee form (IKDC-SKF) was also compared.

Results

The Ramp group consisted of 21 patients (age: 24 ± 8 years, 10 male, 11 female), and Control group consisted of 44 patients (age: 26 ± 13 years, 23 male, 21 female) after excluding those with other medial/lateral meniscus injuries. All ramp lesions were repaired using an all-inside device, and healing was confirmed via second-look arthroscopy at one year postoperatively. Preoperatively, the SSD in ATT during the Lachman test was significantly larger in the Ramp group (6.3 ± 3.7 mm vs 4.0 ± 4.5 mm, P < 0.05). However, no significant difference was observed between the two groups one year postoperatively (0.8 ± 3.9 mm vs 1.4 ± 4.1 mm, P = 0.566). No significant preoperative difference was found in posterior tibial acceleration during the pivot-shift test (1.5 ± 1.0 m/s² vs 1.6 ± 0.9 m/s², P = 0.707), but a small yet significant difference was observed postoperatively (0.8 ± 0.9 m/s² vs 1.3 ± 0.7 m/s², P < 0.05). There were no significant differences in SSD in ATT using the KT-2000 or in IKDC-SKF scores preoperatively and postoperatively.

Conclusion

Preoperative increased anterior knee instability was observed in the Ramp group, but postoperative anterior knee stability was comparable to the Control group. In addition, repaired ramp lesions did not adversely affect postoperative outcomes. The present findings suggest that medial meniscus ramp lesion repair may restore knee stability in ACL reconstruction.