Your Guide to Cutting-Edge Healthcare: ArthroKinetix Newsletter #3!

Introduction

Meniscal ramp lesions involve a peripheral posterior horn medial meniscal tear or a menisco-capsular separation. Hiding in the back of the knee they often go unnoticed during MRI evaluation as well as during arthroscopy. There is a known association of meniscal ramp lesions with ACL tears and therefore failure to address this injury may adversely effect recovery and function. Additionally, if left untreated, meniscal ramp lesions can cause knee instability and lead to early osteoarthritis. Repair of meniscal ramp lesions has been shown to improve stability and overall knee function.

Anatomy and Biomechanics

The posterior capsular junction of the medial meniscus is composed of the meniscocapsular ligament superiorly and the meniscotibial ligament inferiorly(see diagram). Together with the posterior horn of the medial meniscus, they stabilize the knee against anterior tibial translation and posteromedial rotation. Repair must address both the attachment of the meniscocapsular ligament and the meniscotibial ligament. The goal in meniscal ramp repair is ultimate healing and restoration of meniscal function.

Diagnosis

Meniscal ramp lesions are optimally detected during routine MRI, but studies have reported a variable sensitivity and specificity for the detection. Irregularity at the posterior margin and complete fluid filling are the most sensitive findings on MRI for detecting ramp lesions(see photo). Because of the variable sensitive/specificity by MRI, arthroscopy is recommended for definitive assessment and classification.

Treatment

The two most common repair techniques are the "all-inside" repair versus the "inside-out" repair. Advantages of all-inside techniques are reduced operative times, lower risk of surgical complication (nerve injury or irritation), and faster recovery times. Inside-out repairs are the historic gold standard, but with modern improvements in all suture implants, the all-inside repairs are now often associated with equivalent functional outcomes and healing rates. Inside-out techniques require an additional posterior medial incision and soft tissue retractor which can result in higher risk of operative injury or complications.

Conclusion

Meniscal ramp lesions are a distinct type of meniscal tear presenting diagnostic challenges due to their subtle presentation. A high index of suspicion, combined with advanced MRI imaging techniques and diagnostic arthroscopy is required for accurate diagnosis. Meniscal ramp lesions often occur in the setting of anterior cruciate ligament ruptures and repair helps restore stability.

Kinetic Moon Pearls

• Meniscal ramp injuries are peripheral injuries affecting the posterior horn of medial meniscus often in the setting of ACL tears.

• Ramp lesions include medial meniscus peripheral tears, meniscocapsular separation and meniscotibial ligament injuries.

• MRI is imaging of choice but variable sensitivity and specificity in establishing the diagnosis

• Surgical arthroscopy of posteromedial compartment of the knee is needed for diagnosis and treatment.

Shape the Future Gallery

The inaugural ArthroKinetix mintable is the first in a series based on the orthopedic Tree of Andry. The Tree of Andry is an image of a tree tied to a wooden stake for support. Created by French physician and professor of medicine Nicolas Andry in his 1741 book L'orthopedie. The image compares the correction of deformities in children to straightening a young tree, and has become a universal symbol in orthopedics.

ArthroKinetix, as a modern, web3 based orthopedic newsletter, seeks to expand the Andry tree symbolism with the potential to showcase interactive healthcare data and its visualization. More to come on this later..... hope enjoy the art and lets shape the future!

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