Twin Cities Orthopaedics, Edina, Minnesota.
University of Vermont, Larner College of Medicine, Orthopaedics and Rehabilitation, Burlington, Vermont, U.S.A..
Arthroscopy. 2022 Mar;38(3):670-672. doi: 10.1016/j.arthro.2022.01.003.
Meniscal tear patterns associated with anterior cruciate ligament (ACL) tears, such as root tears and ramp lesions are common but less easily recognized on magnetic resonance imaging (MRI) compared with a complete radial tear or a locked bucket-handle tear. Timely treatment of these tears improves outcomes in the setting of ACL reconstruction. While physical examination does not enable a definitive diagnosis of meniscal root tears and ramp lesions, high-grade laxity, including a 3+ Lachman and 3+ pivot shift, should raise suspicions for these tear patterns. MRI allows visualization of both root tears and ramp lesions, although the gold standard for diagnosis is probing at the time of arthroscopy due to a high false-negative rate on MRI. Up to 17% of patients with an ACL tear have a lateral meniscal root tear; a contact mechanism and increased posterior slope are both associated with a greater incidence of lateral meniscal root tears and these are repaired with a tunnel technique. Meniscal ramp lesions occur in up to 41% of patients with ACL tears due to a contact mechanism, and we prefer repair with an inside-out technique. More than 60% of complete radial meniscal tears occur in the setting of ACL tears and are preferentially repaired with a hashtag technique for minimally separated tears and a 2-tunnel technique combined with an inside-out repair for more severe tears. Bucket-handle tears are more common in the setting of chronic ACL deficiency; concurrent with ACL reconstruction urgent meniscal repair with an inside-out technique is the gold standard, which allows for precise approximation of the tear with multiple points of fixation for improved biomechanical performance. It is critical to identify and treat these tears during ACL reconstruction because of their role as secondary stabilizers and for long-term chondral protection.
前交叉韧带 (ACL) 撕裂相关的半月板撕裂模式，如根部撕裂和斜坡病变较为常见，但与完全放射状撕裂或锁定桶柄状撕裂相比，在磁共振成像 (MRI) 上较难识别。这些撕裂的及时治疗可改善 ACL 重建后的效果。虽然体格检查不能明确诊断半月板根部撕裂和斜坡病变，但高度松弛，包括 3+Lachman 和 3+轴心转移试验，应怀疑存在这些撕裂模式。MRI 可显示根部撕裂和斜坡病变，但由于 MRI 的假阴性率较高，关节镜检查时的探查仍是诊断的金标准。多达 17%的 ACL 撕裂患者存在外侧半月板根部撕裂；接触机制和后斜率增加均与外侧半月板根部撕裂的发生率增加相关，这些撕裂采用隧道技术修复。由于接触机制，多达 41%的 ACL 撕裂患者存在半月板斜坡病变，我们更倾向于采用内-外技术进行修复。超过 60%的完全放射状半月板撕裂发生在 ACL 撕裂的情况下，对于最小分离撕裂采用 hashtag 技术和更严重撕裂采用 2 隧道技术结合内-外修复的方法进行修复。桶柄状撕裂在慢性 ACL 缺失的情况下更为常见；与 ACL 重建同时，采用内-外技术紧急半月板修复是金标准，可通过多点固定精确接近撕裂，提高生物力学性能。在 ACL 重建过程中识别和治疗这些撕裂至关重要，因为它们作为次要稳定器，可长期保护软骨。
