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Published on: April 30, 2014
Role of Meniscal Ramp Lesion Repair in Preventing Residual Instability after Anterior Cruciate Ligament
Nisanth Velu Selvaraj1, Sitansu Sekhar Samantaray2, Suhail Ahmad Khanday3
1Department of Orthopaedics, Paalana Institute of Medical Sciences, Palakkad, Kerala, India.
Introduction:
Anterior cruciate ligament reconstruction (ACLR) is a common procedure done to regain knee stability, but even after the technical success of the operation; some patients still experience residual instability. Anterior cruciate ligament (ACL) injuries are regularly accompanied by meniscal ramp lesions, which concern the posteromedial meniscocapsular junction and can lead to a persistent anterior and rotational laxity in case of inadequate treatment. Whether ramp lesion repair could help in avoiding residual instability after ACLR is a controversial issue.
Materials And Methods:
The proposed study is a prospective observational comparative study involving 50 participants who planned to undergo arthroscopic ACLR as a primary operation in a tertiary care unit. The findings during intraoperative were used to categorize the patients into two groups: Group A (ACLR and concomitant ramp lesion repair; n = 25) and Group B (isolated ACLR and no ramp lesion; n = 25). Lachman test and pivot-shift test were used to measure post-operative knee stability, and Lysholm Knee Scoring Scale and subjective International Knee Documentation Committee (IKDC) score at six months follow-up were used to measure functional outcomes.
Results:
Group A exhibited a high rate of post-operative knee stability, with 88% having a negative Lachman test in comparison to Group B (72%), with residual pivot-shift positivity being significantly low in Group A (16%) compared to Group B (40%) (P = 0.03). The ramp repair group also performed better in terms of functional outcomes, having a higher mean Lysholm score (93.6 ± 4.8 vs. 88.9 ± 6.2) and a high percentage of normal IKDC score (56 vs. 32). The parameters of residual instability were much lower in patients who received ramp lesion repair.
Conclusion:
Meniscal ramp lesion repair done together with ACLR enhanced substantially residual knee instability and short-term functional outcomes. This can be improved by systematic assessment and proper management of ramp lesions during ACLR to increase the stability of the knee post-surgery and maximize patient outcomes.
