Skip to main content

Advertisement

SpringerLink
Log in

Medial meniscus ramp and lateral meniscus posterior root lesions are present in more than a third of primary and revision ACL reconstructions

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was (1) to describe the meniscus tear pattern in anterior cruciate ligament (ACL)-injured patients, with a special focus on medial meniscus (MM) ramp lesions and lateral meniscus (LM) root tears and (2) to determine whether patient and injury characteristics were associated with meniscus tear patterns.

Methods

Data from 358 cases of ACL primary and revision reconstruction surgeries were extracted from a center-based registry. During arthroscopy, the presence of associated meniscus lesions was documented by systematically inspecting the anterior and posterior tibiofemoral compartments. With a special focus on MM ramp lesions and LM root tears, groups of different injury tear patterns were formed. Chi-square tests were used to determine whether these groups differed with respect to various patient and injury characteristics, including gender, previous ipsilateral ACL injuries, the injury’s relation to sport, person contact during injury and the type of ACL tear. Median age at surgery and body mass index were compared between groups using the Kruskal–Wallis test. Significance was set at p < 0.05.

Results

Two hundred and thirty-nine ACL injuries (67%) showed additional meniscal injuries, of which 125 (52%) involved the MM ramp and/or the LM root. Ramp lesions were more frequent in males (23% vs 12% in females, p < 0.01), in contact injuries (28% vs 16% in non-contact, p < 0.05) and in complete ACL tears (21% vs 5% in partial, p < 0.05). Combined injuries of the MM ramp and the LM root showed a higher percentage of contact injuries compared to non-contact injuries (10% vs 4%, p < 0.05).

Conclusion

Two-thirds of all ACL injuries showed a concomitant meniscus injury, of which half involved the biomechanically relevant, but previously often undiagnosed RLMM or the PRLM. These findings provide evidence that until recently about half of ACL-associated meniscus injuries were not properly identified. Ramp lesions were more frequent in males, contact injuries and in complete ACL tears. These findings stress the need for a systematic assessment and a better understanding of the pathomechanism of these specific injuries which may have an important impact on knee biomechanics and the outcome of ACL reconstruction.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ahn JH, Bae TS, Kang KS, Kang SY, Lee SH (2011) Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability. Am J Sports Med 39:2187–2193

    Article  PubMed  Google Scholar 

  2. Ahn JH, Lee YS, Yoo JC, Chang MJ, Park SJ, Pae YR (2010) Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. Arthroscopy 26:67–75

    Article  PubMed  Google Scholar 

  3. Ahn JH, Oh I (2006) Arthroscopic all-inside lateral meniscus suture using posterolateral portal. Arthroscopy 22(572):e571-574

    Google Scholar 

  4. Anderson AF, Irrgang JJ, Dunn W, Beaufils P, Cohen M, Cole BJ et al (2011) Interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears. Am J Sports Med 39:926–932

    Article  PubMed  Google Scholar 

  5. Balazs GC, Greditzer HG, Wang D, Marom N, Potter HG, Marx RG et al (2019) Ramp lesions of the medial meniscus in patients undergoing primary and revision ACL reconstruction: prevalence and risk factors. Orthop J Sports Med 7:2325967119843509

    Article  PubMed  PubMed Central  Google Scholar 

  6. Balazs GC, Greditzer HG, Wang D, Marom N, Potter HG, Rodeo SA et al (2020) Non-treatment of stable ramp lesions does not degrade clinical outcomes in the setting of primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06017-1

    Article  PubMed  Google Scholar 

  7. Brambilla L, Pulici L, Carimati G, Quaglia A, Prospero E, Bait C et al (2015) Prevalence of associated lesions in anterior cruciate ligament reconstruction: correlation with surgical timing and with patient age, sex, and body mass index. Am J Sports Med 43:2966–2973

    Article  PubMed  Google Scholar 

  8. Bumberger A, Koller U, Hofbauer M, Tiefenboeck TM, Hajdu S, Windhager R et al (2020) Ramp lesions are frequently missed in ACL-deficient knees and should be repaired in case of instability. Knee Surg Sports Traumatol Arthrosc 28:840–854

    Article  PubMed  Google Scholar 

  9. Church S, Keating JF (2005) Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Jt Surg Br 87:1639–1642

    Article  CAS  Google Scholar 

  10. Colombet P, Dejour D, Panisset JC, Siebold R, French Arthroscopy S (2010) Current concept of partial anterior cruciate ligament ruptures. Orthop Traumatol Surg Res 96:S109–S118

    Article  CAS  PubMed  Google Scholar 

  11. DeFranco MJ, Bach BR Jr (2009) A comprehensive review of partial anterior cruciate ligament tears. J Bone Jt Surg Am 91:198–208

    Article  Google Scholar 

  12. Dejour D, Ntagiopoulos PG, Saggin PR, Panisset JC (2013) The diagnostic value of clinical tests, magnetic resonance imaging, and instrumented laxity in the differentiation of complete versus partial anterior cruciate ligament tears. Arthroscopy 29:491–499

    Article  PubMed  Google Scholar 

  13. DePhillipo NN, Moatshe G, Brady A, Chahla J, Aman ZS, Dornan GJ et al (2018) Effect of meniscocapsular and meniscotibial lesions in ACL-deficient and ACL-reconstructed knees: a biomechanical study. Am J Sports Med 46:2422–2431

    Article  PubMed  Google Scholar 

  14. Feucht MJ, Bigdon S, Mehl J, Bode G, Muller-Lantzsch C, Sudkamp NP et al (2015) Risk factors for posterior lateral meniscus root tears in anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 23:140–145

    Article  PubMed  Google Scholar 

  15. Feucht MJ, Salzmann GM, Bode G, Pestka JM, Kuhle J, Sudkamp NP et al (2015) Posterior root tears of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 23:119–125

    Article  PubMed  Google Scholar 

  16. Forkel P, Reuter S, Sprenker F, Achtnich A, Herbst E, Imhoff A et al (2015) Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system. Knee Surg Sports Traumatol Arthrosc 23:112–118

    Article  PubMed  Google Scholar 

  17. Forkel P, von Deimling C, Lacheta L, Imhoff FB, Foehr P, Willinger L et al (2018) Repair of the lateral posterior meniscal root improves stability in an ACL-deficient knee. Knee Surg Sports Traumatol Arthrosc 26:2302–2309

    Article  PubMed  Google Scholar 

  18. Frank JM, Moatshe G, Brady AW, Dornan GJ, Coggins A, Muckenhirn KJ et al (2017) Lateral meniscus posterior root and meniscofemoral ligaments as stabilizing structures in the ACL-deficient knee: a biomechanical study. Orthop J Sports Med 5:2325967117695756

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gillquist J, Hagberg G, Oretorp N (1979) Arthroscopic examination of the posteromedial compartment of the knee joint. Int Orthop 3:13–18

    Article  CAS  PubMed  Google Scholar 

  20. Granan LP, Inacio MC, Maletis GB, Funahashi TT, Engebretsen L (2013) Sport-specific injury pattern recorded during anterior cruciate ligament reconstruction. Am J Sports Med 41:2814–2818

    Article  PubMed  Google Scholar 

  21. Greif DN, Baraga MG, Rizzo MG, Mohile NV, Silva FD, Fox T et al (2020) MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation. Skelet Radiol 49:677–689

    Article  Google Scholar 

  22. Grindem H, Eitzen I, Engebretsen L, Snyder-Mackler L, Risberg MA (2014) Nonsurgical or surgical treatment of ACL injuries: knee function, sports participation, and knee reinjury: the Delaware-Oslo ACL Cohort Study. J Bone Jt Surg Am 96:1233–1241

    Article  Google Scholar 

  23. Hamberg P, Gillquist J, Lysholm J (1983) Suture of new and old peripheral meniscus tears. J Bone Jt Surg Am 65:193–197

    Article  CAS  Google Scholar 

  24. Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ (2002) Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Jt Surg Am 84:1560–1572

    Article  Google Scholar 

  25. Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32:629–634

    Article  PubMed  Google Scholar 

  26. Krych AJ, Wu IT, Desai VS, Murthy NS, Collins MS, Saris DBF et al (2018) High rate of missed lateral meniscus posterior root tears on preoperative magnetic resonance imaging. Orthop J Sports Med 6:2325967118765722

    PubMed  PubMed Central  Google Scholar 

  27. Liu X, Feng H, Zhang H, Hong L, Wang XS, Zhang J (2011) Arthroscopic prevalence of ramp lesion in 868 patients with anterior cruciate ligament injury. Am J Sports Med 39:832–837

    Article  PubMed  Google Scholar 

  28. Lording T, Corbo G, Bryant D, Burkhart TA, Getgood A (2017) Rotational laxity control by the anterolateral ligament and the lateral meniscus is dependent on knee flexion angle: a cadaveric biomechanical study. Clin Orthop Relat Res 475:2401–2408

    Article  PubMed  PubMed Central  Google Scholar 

  29. Magnussen RA, Spindler KP (2011) The effect of patient and injury factors on long-term outcome after anterior cruciate ligament reconstruction. Curr Orthop Pract 22:90–103

    Article  PubMed  PubMed Central  Google Scholar 

  30. Minami T, Muneta T, Sekiya I, Watanabe T, Mochizuki T, Horie M et al (2018) Lateral meniscus posterior root tear contributes to anterolateral rotational instability and meniscus extrusion in anterior cruciate ligament-injured patients. Knee Surg Sports Traumatol Arthrosc 26:1174–1181

    PubMed  Google Scholar 

  31. Mouton C, Magosch A, Pape D, Hoffmann A, Nuhrenborger C, Seil R (2020) Ramp lesions of the medial meniscus are associated with a higher grade of dynamic rotatory laxity in ACL-injured patients in comparison to patients with an isolated injury. Knee Surg Sports Traumatol Arthrosc 28:1023–1028

    Article  PubMed  Google Scholar 

  32. Musahl V, Rahnemai-Azar AA, Costello J, Arner JW, Fu FH, Hoshino Y et al (2016) The influence of meniscal and anterolateral capsular injury on knee laxity in patients with anterior cruciate ligament injuries. Am J Sports Med 44:3126–3131

    Article  PubMed  Google Scholar 

  33. Peltier A, Lording T, Maubisson L, Ballis R, Neyret P, Lustig S (2015) The role of the meniscotibial ligament in posteromedial rotational knee stability. Knee Surg Sports Traumatol Arthrosc 23:2967–2973

    Article  CAS  PubMed  Google Scholar 

  34. Praz C, Vieira TD, Saithna A, Rosentiel N, Kandhari V, Nogueira H et al (2019) Risk factors for lateral meniscus posterior root tears in the anterior cruciate ligament-injured knee: an epidemiological analysis of 3956 patients from the SANTI Study Group. Am J Sports Med 47:598–605

    Article  PubMed  Google Scholar 

  35. Prentice HA, Lind M, Mouton C, Persson A, Magnusson H, Gabr A et al (2018) Patient demographic and surgical characteristics in anterior cruciate ligament reconstruction: a description of registries from six countries. Br J Sports Med 52:716–722

    Article  PubMed  Google Scholar 

  36. Ristanis S, Stergiou N, Patras K, Vasiliadis HS, Giakas G, Georgoulis AD (2005) Excessive tibial rotation during high-demand activities is not restored by anterior cruciate ligament reconstruction. Arthroscopy 21:1323–1329

    Article  PubMed  Google Scholar 

  37. Seil R, Hoffmann A, Scheffler S, Theisen D, Mouton C, Pape D (2017) Ramp lesions: tips and tricks in diagnostics and therapy. Orthopade 46:846–854

    Article  CAS  PubMed  Google Scholar 

  38. Seil R, Mouton C, Coquay J, Hoffmann A, Nuhrenborger C, Pape D et al (2018) Ramp lesions associated with ACL injuries are more likely to be present in contact injuries and complete ACL tears. Knee Surg Sports Traumatol Arthrosc 26:1080–1085

    PubMed  Google Scholar 

  39. Shybut TB, Vega CE, Haddad J, Alexander JW, Gold JE, Noble PC et al (2015) Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 43:905–911

    Article  PubMed  Google Scholar 

  40. Song GY, Liu X, Zhang H, Wang QQ, Zhang J, Li Y et al (2016) Increased medial meniscal slope is associated with greater risk of ramp lesion in noncontact anterior cruciate ligament injury. Am J Sports Med 44:2039–2046

    Article  PubMed  Google Scholar 

  41. Sonnery-Cottet B, Conteduca J, Thaunat M, Gunepin FX, Seil R (2014) Hidden lesions of the posterior horn of the medial meniscus: a systematic arthroscopic exploration of the concealed portion of the knee. Am J Sports Med 42:921–926

    Article  PubMed  Google Scholar 

  42. Sonnery-Cottet B, Praz C, Rosenstiel N, Blakeney WG, Ouanezar H, Kandhari V et al (2018) Epidemiological evaluation of meniscal ramp lesions in 3214 anterior cruciate ligament-injured knees from the SANTI Study Group Database: a risk factor analysis and study of secondary meniscectomy rates following 769 ramp repairs. Am J Sports Med 46:3189–3197

    Article  PubMed  Google Scholar 

  43. Stephen JM, Kittl C, Williams A, Zaffagnini S, Marcheggiani Muccioli GM, Fink C et al (2016) Effect of medial patellofemoral ligament reconstruction method on patellofemoral contact pressures and kinematics. Am J Sports Med 44:1186–1194

    Article  PubMed  Google Scholar 

  44. Tashman S, Collon D, Anderson K, Kolowich P, Anderst W (2004) Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med 32:975–983

    Article  PubMed  Google Scholar 

  45. Thaunat M, Fayard JM, Guimaraes TM, Jan N, Murphy CG, Sonnery-Cottet B (2016) Classification and surgical repair of ramp lesions of the medial meniscus. Arthrosc Tech 5:e871–e875

    Article  PubMed  PubMed Central  Google Scholar 

  46. Thompson WO, Thaete FL, Fu FH, Dye SF (1991) Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. Am J Sports Med 19:210–215 ((discussion 215–216))

    Article  CAS  PubMed  Google Scholar 

  47. Tomczak M, Tomczak E (2014) The need to report effect size estimates revisited. An overview of some recommended measures of effect size. Trends Sports Sci 21:19–25

    Google Scholar 

  48. Vedi V, Williams A, Tennant SJ, Spouse E, Hunt DM, Gedroyc WM (1999) Meniscal movement. An in-vivo study using dynamic MRI. J Bone Jt Surg Br 81:37–41

    Article  CAS  Google Scholar 

Download references

Acknowledgements

Project honored with the GOTS Young Investigator Award by Bauerfeind.

Funding

None.

Author information

Authors and Affiliations

  1. Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d’Eich, 78, rue d’ Eich, 1460, Luxembourg, Luxembourg

    Amanda Magosch, Caroline Mouton, Christian Nührenbörger & Romain Seil

  2. Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg

    Caroline Mouton, Christian Nührenbörger & Romain Seil

  3. Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg

    Romain Seil

Authors
  1. Amanda Magosch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Caroline Mouton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian Nührenbörger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Romain Seil
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed equally to the study.

Corresponding author

Correspondence to Romain Seil.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was provided by National Ethics Committee for Research (No. 201101/05).

Informed consent

All patients signed an informed consent to participate in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Magosch, A., Mouton, C., Nührenbörger, C. et al. Medial meniscus ramp and lateral meniscus posterior root lesions are present in more than a third of primary and revision ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 29, 3059–3067 (2021). https://doi.org/10.1007/s00167-020-06352-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-06352-3

Keywords

Search

Navigation