Tollefson Luke V, Tuca Maria Jesus, Tapasvi Sachin, LaPrade Robert F
Twin Cities Orthopedics, Edina, MN, USA.
Department of Orthopedics and Trauma, School of Medicine, Pontifical Catholic University of Chile, Chile; Mutual de Seguridad Clinical Hospital, Chile.
J ISAKOS. 2025 Feb;10:100380. doi: 10.1016/j.jisako.2024.100380. Epub 2024 Dec 31.
Medial meniscus ramp tears are tears of the posteromedial capsule or peripheral rim of the posteromedial meniscus that frequently occur with anterior cruciate ligament (ACL) tears. The incidence and prevalence of medial meniscus ramp tears has been increasing in the recent literature due to the increased understanding of the anatomy and diagnosis of these tears. When a patient presents with an ACL tear, a medial meniscus ramp tear should be suspected if the patient has a grade 3+ Lachman or pivot-shift exam, a vertical line of increased signal intensity in the posterior capsule or peripheral meniscus on magnetic resonance imaging (MRI), or posteromedial tibial plateau bone bruising on MRI. When a ramp tear is suspected, proper arthroscopic probing, including utilizing the transnotch view (or potentially an accessory posteromedial portal) or performing a medial collateral ligament trephination should be considered as part of the diagnostic workup. Once a tear is identified, a surgical repair depends on the location and stability of the tear and the surgeon's preference. The most frequently utilized techniques include the all-inside device, an all-inside suture hook, and an inside-out repair. Studies reporting on clinical outcomes for patients with ramp tears generally report no difference in outcomes compared to isolated ACL reconstruction patients. No consensus has been made on the best repair technique; however, it is generally accepted that repair is superior to leaving a ramp tear in situ as ramp tears have the potential to progress into bucket-handle tears. Further studies should work to establish a surgically and anatomically relevant classification system that clearly defines tear locations and stability to better study patient outcomes for those with a medial meniscus ramp tear. The purpose of this article is to review the anatomy, diagnosis, and treatment of medial meniscus ramp tears.
内侧半月板斜坡撕裂是后内侧关节囊或后内侧半月板外周缘的撕裂，常与前交叉韧带（ACL）撕裂同时发生。由于对这些撕裂的解剖结构和诊断有了更多了解，近年来内侧半月板斜坡撕裂的发病率和患病率一直在上升。当患者出现ACL撕裂时，如果患者Lachman试验或轴移试验为3级以上，磁共振成像（MRI）显示后关节囊或半月板外周缘有垂直的信号增强线，或MRI显示胫骨平台后内侧骨挫伤，则应怀疑存在内侧半月板斜坡撕裂。当怀疑有斜坡撕裂时，适当的关节镜探查，包括使用经髁间窝入路（或可能使用辅助后内侧入路）或进行内侧副韧带环钻术，应被视为诊断检查的一部分。一旦确定撕裂，手术修复取决于撕裂的位置和稳定性以及外科医生的偏好。最常用的技术包括全内装置、全内缝合钩和由内向外修复。关于斜坡撕裂患者临床结果的研究通常报告，与单纯ACL重建患者相比，结果没有差异。对于最佳修复技术尚未达成共识；然而，一般认为修复优于将斜坡撕裂留在原位，因为斜坡撕裂有可能发展为桶柄状撕裂。进一步的研究应致力于建立一个与手术和解剖相关的分类系统，明确定义撕裂位置和稳定性，以便更好地研究内侧半月板斜坡撕裂患者的治疗结果。本文的目的是综述内侧半月板斜坡撕裂的解剖、诊断和治疗。
