Non-treatment of stable ramp lesions does not degrade clinical outcomes in the setting of primary ACL reconstruction

A Letter to the Editor to this article was published on 25 August 2020

Abstract

Purpose

The purpose of this study was to evaluate the clinical outcomes of various methods of treatment of stable and unstable ramp lesions compared to patients with no meniscal pathology at the time of primary ACL reconstruction.

Methods

All patients with a preoperative MRI performed at our facility who were enrolled in an institutional ACL registry and 1-year clinical follow-up were identified. A musculoskeletal radiologist reviewed preoperative MRI scans for evidence of a ramp lesion. Ramp lesions were classified as stable if a peripheral tear of the posterior horn of the medial meniscus was identified by MRI, but did not displace into the medial compartment with anteriorly directed probing at the time of surgery. Ramp lesions were classified as unstable if a tear was identified by preoperative MRI at the meniscocapsular junction and the meniscus was displaceable into the medial compartment with probing. Reoperation rates for ACL graft failure or recurrent medial meniscus pathology were collected. Patient-reported outcome scores (IKDC, SF12 PCS, SF12 MCS, and Marx Activity scale) were recorded at baseline and final follow-up.

Results

A total of 162 patients were included in the analysis with median 2-year (range 1–5 years) clinical follow-up. Patients with a repaired unstable ramp lesion had a significantly higher likelihood of reoperation for recurrent medial meniscus pathology than patients without meniscal pathology at the time of index surgery. Patients with an untreated stable ramp lesion had a similar rate of reoperation when compared to patients without meniscal pathology. At final follow-up, there was no difference between groups in IKDC score, SF12 PCS/MCS, or Marx activity score or change in any score.

Conclusions

Patients with untreated stable ramp lesions have similar clinical outcomes at median 2-year (range 1–5 years) follow-up when compared to patients without a ramp lesion. Treatment of stable ramp lesions at the time of ACL reconstruction does not have clinical benefit.

Level of evidence

III.

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Correspondence to George C. Balazs.

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Conflict of Interest

GCB, HGG, NM, and DW report that they have no conflicts of interest in the authorship and publication of this article. SAR declares that he has received royalties from Zimmer Biomet, has stock options from Ortho RTI, and has served as a consultant to Advance Medical. RGM declares that he has received royalties from Springer and Demos Health, and has received equity compensation from MEND Nutrition. HGG declares that she has received research support from GE Healthcare and GE/NBA, has served as a consultant to Ortho RTI and Smith & Nephew, and owns stock or stock options in Imagen. RJW declares that he has received research support from Histogenics Inc, royalties from Arthrex, has served as a consultant to JRF Ortho, and owns stock or stock options in Cymedica, Gramercy Extremity Orthopedics, Pristine Surgical, and RecoverX.

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No funding was received in support of this project.

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Ethical approval was granted by the Hospital for Special Surgery Institutional Review Board.

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Investigation performed at Hospital for Special Surgery, New York, NY.

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Balazs, G.C., Greditzer, H.G., Wang, D. et al. Non-treatment of stable ramp lesions does not degrade clinical outcomes in the setting of primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 28, 3576–3586 (2020). https://doi.org/10.1007/s00167-020-06017-1

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Keywords

  • ACL
  • Meniscus
  • Knee
  • Ramp lesion