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Posterior Approach Ramp Lesion Repair Using an All-Inside Meniscal Repair Device in Hamstring Anterior Cruciate
1Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Purpose:
To compare the second-look arthroscopic healing status, functional outcomes, and complications between anterior- and posterior-approach repairs for medial meniscal ramp lesions using all-inside meniscal repair devices in patients undergoing anterior cruciate ligament reconstruction.
Methods:
This retrospective study included patients with anterior cruciate ligament injuries who underwent medial meniscal posterior horn ramp lesion repair between January 2015 and January 2019. Inclusion criteria were a minimum follow-up of 2 years and second-look arthroscopy performed approximately 1 year postoperatively. Patients were divided into an anterior-approach repair group and a posterior-approach repair group. Postoperative healing status was classifiedas follows: (1) healed, (2) partially healed, and (3) failed. Clinical outcomes (anterior laxity, pivot shift, Lysholm score, subjective International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, Tegner score, and meniscal retear rate) according to the repair technique were compared between the two groups.
Results:
Eighty-one patients with anterior cruciate ligament injuries underwent medial meniscal posterior horn ramp lesion repair and were divided into an anterior-approach repair group (n = 40) and a posterior-approach repair group (n = 41). In the posterior-approach repair group, 40 patients (97.6%) showed complete healing compared with 21 patients (52.5%) in the anterior-approach repair group. Partial healing was observed in 12 patients (14.8%), with 1 patient (2.4%) in the posterior-approach repair group and 11 patients (27.5%) in the anterior-approach repair group. Failure of healing occurred in 8 patients (9.9%), all of whom were in the anterior approach group (20%). There were no significant differences in postoperative Tegner, Lysholm, International Knee Documentation Committee score, and Knee injury and Osteoarthritis Outcome Score scores between the 2 groups. The minimum clinically important difference was fixed at IKDC = 18.9, Lysholm = 10.1, and Tegner score = 1.0.
Conclusions:
Posterior-approach repair of medial meniscal posterior horn ramp lesions using the all-inside meniscal repair devices resulted in superior healing compared with the anterior-approach.
Level Of Evidence:
Level III, retrospective comparative study.
