Gupta Sheetal, Kovvuru Kranthi Kiran, Vashistha Deepak
Orthopaedics, Galaxy Hospital, Bhopal, India.
Video J Sports Med. 2023 Aug 3;3(4):26350254231176832. doi: 10.1177/26350254231176832. eCollection 2023 Jul-Aug.
A "ramp lesion" is described as an injury involving the peripheral attachment of the posterior horn of the medial meniscus. Ramp lesions are associated with increased loads on anterior cruciate ligament and leads to rotatory instability of knee. During anterior cruciate ligament reconstruction, failure to identify and treat ramp lesion leads to increased forces on the reconstructed graft and residual instability which ultimately increases chances for graft failure. It is important to identify the ramp lesions by looking at the posterior compartment and repair ramp lesion. Ramp lesions are still a challenge to treat due to misdiagnosis and long learning curve of current techniques. In this technique, we are presenting margin convergence shoelace technique to repair a large ramp lesion.
Isolated ramp lesions or ramp lesions associated with other ligamentous injuries.
Through standard anteromedial and anterolateral portals, diagnostic arthroscopy is done. Using Gillquist maneuver, posteromedial compartment is visualized to look for ramp lesion. Probing is done with 18-gauge spinal needle from posteromedial aspect of knee to look for hidden lesions and extent of tear. We use 2 additional portals, low and high posteromedial portals for ramp repair. Visualizing from anterolateral portal entry is made in the posteromedial compartment; low posteromedial portal is created at the level of meniscus; 8-mm passport cannula is inserted and used as working portal; and then, high posteromedial portal is created and used as viewing portal. Visualizing through high posteromedial portal rasping of ramp lesion is done. Now with knee scorpion loaded with 2-0 fiber wire, bites are taken along posterior margin of meniscus and capsular portion of tear edges alternatively in shoelace manner from lateral to medial. Finally, compression and knot tying are done and secured with multiple half hitches.
Surgical repair of ramp lesions is associated with good healing, and it restores stability of knee. Follow-up of more than 2 years shows better functional outcome and reduced retear rates.
DISCUSSION/CONCLUSION: Currently, there are a lot of techniques described for ramp repair. We present arthroscopic ramp repair with dual posteromedial portals by shoelace technique, which is a safe, easy, and cost-effective method and gives excellent results and good healing especially in larger tears.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
“斜坡损伤”被描述为涉及内侧半月板后角周边附着处的损伤。斜坡损伤与前交叉韧带负荷增加相关，并导致膝关节旋转不稳定。在前交叉韧带重建过程中，未能识别和治疗斜坡损伤会导致重建移植物上的力增加以及残余不稳定，最终增加移植物失败的几率。通过观察后关节腔来识别斜坡损伤并修复斜坡损伤很重要。由于误诊和当前技术的学习曲线较长，斜坡损伤的治疗仍然是一项挑战。在本技术中，我们介绍边缘汇聚鞋带技术来修复大型斜坡损伤。
孤立的斜坡损伤或与其他韧带损伤相关的斜坡损伤。
通过标准的前内侧和前外侧入路进行诊断性关节镜检查。使用吉尔奎斯特手法，观察后内侧关节腔以寻找斜坡损伤。用18号脊椎穿刺针从膝关节后内侧进行探查，以寻找隐藏的损伤和撕裂范围。我们另外使用两个入路，即低位和高位后内侧入路进行斜坡修复。从前外侧入路观察，在关节镜下进入后内侧关节腔；在半月板水平创建低位后内侧入路；插入8毫米的通用套管并用作工作通道；然后，创建高位后内侧入路并用作观察通道。通过高位后内侧入路观察，对斜坡损伤进行锉磨。现在，将膝关节置于“蝎子位”，用2-0纤维线，从外侧向内侧以鞋带方式交替咬除半月板后缘和撕裂边缘的关节囊部分。最后，进行加压和打结，并用多个半结固定。
斜坡损伤的手术修复愈合良好，并恢复了膝关节的稳定性。超过2年的随访显示功能结果更好，再撕裂率降低。
讨论/结论：目前，有许多描述斜坡修复的技术。我们介绍了通过鞋带技术采用双后内侧入路的关节镜斜坡修复术，这是一种安全、简便且经济有效的方法，尤其对于较大的撕裂伤，能取得优异的效果和良好的愈合。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本稿件提交包含患者发布声明或其他书面批准形式的文件以供发表。
