Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sonekita-machi, Kokura-minami-ku, Kitakyushu, 800-0296, Japan.
Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
Knee Surg Sports Traumatol Arthrosc. 2020 Nov;28(11):3569-3575. doi: 10.1007/s00167-020-06161-8. Epub 2020 Aug 7.
To determine the incidence of meniscal ramp lesions in an anterior cruciate ligament (ACL) injured knees and to clarify whether ramp lesions are related to chronic ACL deficiency and increased knee instability.
Consecutive ACL injured patients were evaluated arthroscopically for a ramp lesion via a trans-notch view and evidence of menisco-capsular injury was recorded. Other concomitant injuries to the knee were also noted. Incidence of meniscal ramp lesions, delay before surgery, and anterior-posterior stability was analyzed. All patients underwent bilateral KT-2000 evaluation.
One hundred and three consecutive ACL injured patients with a mean age of 24 years were included in this study. In total, a ramp lesion was found in 10 knees (9.7%) via a trans-notch view. None of these lesions could be identified by the standard view from the anterolateral portal. Other medial meniscal lesions were found in 26 knees (25.2%) by standard arthroscopic viewing. The ramp lesion group had significantly longer delay before surgery with a median of 191 days (p < 0.01) as well as a larger side-to-side difference of KT-2000 measurement (7.3 ± 1.8 mm; p < 0.01), compared with the intact medial meniscus group (53 days and 5.5 ± 1.5 mm, respectively).
Ramp lesions that were identified using a trans-notch view were not visualized with standard arthroscopic views. Increased anterior tibial translation and longer delay before surgery were seen in knees with ramp lesions. Careful inspection of the posteromedial menisco-capsular region is required as hidden menisco-capsular lesions may occur which may result in residual knee instability.
Level II.
确定前交叉韧带（ACL）损伤膝关节中半月板前角损伤的发生率，并阐明半月板前角损伤是否与慢性 ACL 缺失和膝关节不稳定增加有关。
对连续的 ACL 损伤患者进行关节镜检查，通过经切迹视图评估半月板前角病变，并记录半月板-囊损伤的证据。还记录了膝关节的其他伴随损伤。分析半月板前角病变的发生率、手术延迟时间和前后稳定性。所有患者均行双侧 KT-2000 评估。
本研究共纳入 103 例连续 ACL 损伤患者，平均年龄 24 岁。共有 10 个膝关节（9.7%）通过经切迹视图发现半月板前角病变。这些病变均无法通过前外侧入路的标准视图识别。通过标准关节镜检查发现 26 个膝关节（25.2%）存在其他内侧半月板病变。半月板前角病变组的手术延迟时间明显较长，中位数为 191 天（p < 0.01），KT-2000 测量的侧-侧差值也较大（7.3 ± 1.8 毫米；p < 0.01），与内侧半月板完整组相比（分别为 53 天和 5.5 ± 1.5 毫米）。
使用经切迹视图识别的半月板前角病变无法通过标准关节镜视图观察到。半月板前角病变的膝关节存在胫骨前向过度位移增加和手术延迟时间延长。需要仔细检查后内侧半月板-囊区域，因为可能会发生隐匿性半月板-囊损伤，导致膝关节残留不稳定。
II 级。
