Ramp Lesion repair by Dr Prathmesh Jain скачать в хорошем качестве

Ramp Lesion repair by Dr Prathmesh Jain

Peripheral injuries affecting posterior horn of medial meniscus in the setting of ACL tears are called ramp lesions. Ramp lesions include peripheral tears, meniscocapsular separation and meniscotibial ligament injuries. Some classifications have addressed meniscal ramp lesions, with good reproducibility by MRI. Surgical exploration of posteromedial compartment of the knee is needed. Background Meniscal ramp lesions consist in longitudinal vertical and/or oblique peripheral tears affecting the posterior horn of medial meniscus that may lead to meniscocapsular or meniscotibial disruption, in the setting of an ACL tear [1]. The coexistence of an ACL tear and other capsular and ligament injuries has been extensively described [2]. Acute ACL tear is associated with meniscal injuries in more than 50% of subjects, and in more than 80% of chronic ACL tear cases. Medial meniscus is firmly attached to the tibia and femur, acting as a knee stabilizer, and preventing anterior translation, especially in the ACL-deficient knee, thus being especially susceptible to injuries [3]. Ramp lesions have important biomechanical consequences, and they occur much more frequently than thought. Ramp lesions remain significantly underdiagnosed and therefore are not promptly surgically repaired in standard knee arthroscopies, since it relies on anterior portals, limiting a full assessment of the posterior horn and attachment of the medial meniscus [4]. Recent data and definition of risk factors bring an appropriate index of suspicion, identification, and adequate therapeutic planning for ramp lesions [5]. A systematic approach using MRI, and especially, arthroscopic exploration of the posteromedial compartment of the knee using a specific trans-notch approach is needed to clearly assess a meniscal ramp lesion [6]. Since this type of injury is often missed, both during MRI reading and due to its "blind" point of arthroscopic vision, it is crucial to make an accurate preoperative diagnosis. The aim of this article is to educate in an illustrative manner the recent literature findings of meniscal ramp lesions, including its anatomical, biomechanical and diagnostic features