Increased Medial Posterior Tibial Slope Associated With Ramp Lesion Healing Failure After All-Inside Device Repair in...

To assess the healing status of ramp lesions repaired using all-inside devices via second-look arthroscopy and to identify risk factors associated with healing failure.

This study reviewed patients treated between 2016 and 2022 who underwent primary anterior cruciate ligament (ACL) reconstruction with concurrent ramp lesion treatment. All unstable ramp lesions were repaired using all-inside devices, whereas stable lesions received rasping only. Inclusion required a minimum 2-year follow-up. Healing status was evaluated by second-look arthroscopy and categorized as complete, incomplete, or failed. Clinical outcomes, including ACL graft failure, residual pivot shift, and patient-reported outcomes, were assessed. Risk factors for healing failure were analyzed.

Sixty-six patients were included. Of the 58 patients with unstable ramp lesions, 33 (56.9%) achieved complete healing, 14 (24.1%) incomplete healing, and 11 (19.0%) failed healing. All 8 patients with stable ramp lesions achieved either complete or incomplete healing. Rates of ACL graft failure and residual pivot shift were numerically highest in the failed healing group, but these differences were not significant. Patient-reported outcomes improved significantly postoperatively with no intergroup differences. Furthermore, a high proportion of patients in all groups achieved the minimal clinically important difference, with over 90% of patients in each group reaching the minimal clinically important difference for the Lysholm score. A steeper medial posterior tibial slope was the only significant predictor of healing failure (P = .023), with receiver operating characteristic curve analysis identifying a medial posterior tibial slope ≥7 degrees as an optimal threshold.

Second-look arthroscopy showed satisfactory healing rates for unstable ramp lesions repaired with all-inside devices during ACL reconstruction, with 56.9% achieving complete healing, 24.1% incomplete healing, and 19.0% failed healing. While healing status did not affect short-term clinical outcomes, an increased medial posterior tibial slope (≥7 degrees) was a significant predictor for healing failure.

Level IV, retrospective case series.