Cargando…
Healing Status of Meniscal Ramp Lesion Affects Anterior Knee Stability After ACL Reconstruction
BACKGROUND: Although the biomechanical importance of the ramp lesion in the anterior cruciate ligament (ACL)–deficient knee has been demonstrated, there is no clear consensus on the appropriate treatment for ramp lesions during ACL reconstruction. PURPOSE: To compare the postoperative outcomes for r...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222250/ https://www.ncbi.nlm.nih.gov/pubmed/32426412 http://dx.doi.org/10.1177/2325967120917674 |
_version_ | 1783533531843002368 |
---|---|
author | Hatayama, Kazuhisa Terauchi, Masanori Saito, Kenichi Takase, Ryota Higuchi, Hiroshi |
author_facet | Hatayama, Kazuhisa Terauchi, Masanori Saito, Kenichi Takase, Ryota Higuchi, Hiroshi |
author_sort | Hatayama, Kazuhisa |
collection | PubMed |
description | BACKGROUND: Although the biomechanical importance of the ramp lesion in the anterior cruciate ligament (ACL)–deficient knee has been demonstrated, there is no clear consensus on the appropriate treatment for ramp lesions during ACL reconstruction. PURPOSE: To compare the postoperative outcomes for ramp lesions between patients treated with all-inside repair through the posteromedial portal and those whose ramp lesions were left in situ without repair during ACL reconstruction. We also determined whether ramp lesion healing status affected postoperative knee stability. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 57 patients who underwent anatomic double-bundle ACL reconstruction between August 2011 and December 2017 had attendant ramp lesions. Of these, 25 ramp lesions that were considered stable were left in situ without repair (Nonrepaired group), and 25 ramp lesions, including 21 stable and 4 unstable lesions, were treated using all-inside repair through the posteromedial portal (Repaired group). We evaluated the side-to-side difference (SSD) in anterior tibial translation on stress radiographs and rotational stability by using the pivot-shift test 2 years after surgery, and healing status of the ramp lesions was evaluated on 3.0-T magnetic resonance imaging (MRI) scans 1 year after surgery. RESULTS: The mean SSDs in anterior translation were 2.4 ± 1.6 mm for the Nonrepaired group and 1.9 ± 1.6 mm for the Repaired group, with no significant differences. The positive ratios on the pivot-shift test were not significantly different between groups. Healing rates of ramp lesions on MRI scans showed a significant difference between the Nonrepaired group (60%) and the Repaired group (100%) (P = .001). The mean SSDs for knees in which the ramp lesion had healed as shown on MRI scans and those in which it had not healed were 1.9 ± 1.6 mm and 3.2 ± 1.1 mm, respectively, which was a significant difference (P = .02). CONCLUSION: Healing rates of ramp lesions were significantly better in the Repaired group than in the Nonrepaired group, although postoperative knee stability was not significantly different between groups. Anterior laxity in the knees in which the ramp lesion was unhealed was significantly greater compared with the knees in which the ramp lesion healed. All-inside repair through the posteromedial portal was a reliable surgical procedure to heal ramp lesions. |
format | Online Article Text |
id | pubmed-7222250 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-72222502020-05-18 Healing Status of Meniscal Ramp Lesion Affects Anterior Knee Stability After ACL Reconstruction Hatayama, Kazuhisa Terauchi, Masanori Saito, Kenichi Takase, Ryota Higuchi, Hiroshi Orthop J Sports Med Article BACKGROUND: Although the biomechanical importance of the ramp lesion in the anterior cruciate ligament (ACL)–deficient knee has been demonstrated, there is no clear consensus on the appropriate treatment for ramp lesions during ACL reconstruction. PURPOSE: To compare the postoperative outcomes for ramp lesions between patients treated with all-inside repair through the posteromedial portal and those whose ramp lesions were left in situ without repair during ACL reconstruction. We also determined whether ramp lesion healing status affected postoperative knee stability. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 57 patients who underwent anatomic double-bundle ACL reconstruction between August 2011 and December 2017 had attendant ramp lesions. Of these, 25 ramp lesions that were considered stable were left in situ without repair (Nonrepaired group), and 25 ramp lesions, including 21 stable and 4 unstable lesions, were treated using all-inside repair through the posteromedial portal (Repaired group). We evaluated the side-to-side difference (SSD) in anterior tibial translation on stress radiographs and rotational stability by using the pivot-shift test 2 years after surgery, and healing status of the ramp lesions was evaluated on 3.0-T magnetic resonance imaging (MRI) scans 1 year after surgery. RESULTS: The mean SSDs in anterior translation were 2.4 ± 1.6 mm for the Nonrepaired group and 1.9 ± 1.6 mm for the Repaired group, with no significant differences. The positive ratios on the pivot-shift test were not significantly different between groups. Healing rates of ramp lesions on MRI scans showed a significant difference between the Nonrepaired group (60%) and the Repaired group (100%) (P = .001). The mean SSDs for knees in which the ramp lesion had healed as shown on MRI scans and those in which it had not healed were 1.9 ± 1.6 mm and 3.2 ± 1.1 mm, respectively, which was a significant difference (P = .02). CONCLUSION: Healing rates of ramp lesions were significantly better in the Repaired group than in the Nonrepaired group, although postoperative knee stability was not significantly different between groups. Anterior laxity in the knees in which the ramp lesion was unhealed was significantly greater compared with the knees in which the ramp lesion healed. All-inside repair through the posteromedial portal was a reliable surgical procedure to heal ramp lesions. SAGE Publications 2020-05-11 /pmc/articles/PMC7222250/ /pubmed/32426412 http://dx.doi.org/10.1177/2325967120917674 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Article Hatayama, Kazuhisa Terauchi, Masanori Saito, Kenichi Takase, Ryota Higuchi, Hiroshi Healing Status of Meniscal Ramp Lesion Affects Anterior Knee Stability After ACL Reconstruction |
title | Healing Status of Meniscal Ramp Lesion Affects Anterior Knee Stability After ACL Reconstruction |
title_full | Healing Status of Meniscal Ramp Lesion Affects Anterior Knee Stability After ACL Reconstruction |
title_fullStr | Healing Status of Meniscal Ramp Lesion Affects Anterior Knee Stability After ACL Reconstruction |
title_full_unstemmed | Healing Status of Meniscal Ramp Lesion Affects Anterior Knee Stability After ACL Reconstruction |
title_short | Healing Status of Meniscal Ramp Lesion Affects Anterior Knee Stability After ACL Reconstruction |
title_sort | healing status of meniscal ramp lesion affects anterior knee stability after acl reconstruction |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222250/ https://www.ncbi.nlm.nih.gov/pubmed/32426412 http://dx.doi.org/10.1177/2325967120917674 |
work_keys_str_mv | AT hatayamakazuhisa healingstatusofmeniscalramplesionaffectsanteriorkneestabilityafteraclreconstruction AT terauchimasanori healingstatusofmeniscalramplesionaffectsanteriorkneestabilityafteraclreconstruction AT saitokenichi healingstatusofmeniscalramplesionaffectsanteriorkneestabilityafteraclreconstruction AT takaseryota healingstatusofmeniscalramplesionaffectsanteriorkneestabilityafteraclreconstruction AT higuchihiroshi healingstatusofmeniscalramplesionaffectsanteriorkneestabilityafteraclreconstruction |