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INTRODUCTION
Data from anterior cruciate ligament (ACL)
registries show that 47-61% of ACL tears are
associated with meniscal lesions [1, 2]. The
most common intra-articular lesion associated
with ACL ruptures involves the posterior horn
of medial meniscus (MM) [3]. A specific type
of MM lesion consists in meniscosynovial or
meniscocapsular tears which can be difficult to
diagnose arthroscopically from the anterior
compartment. These lesions have been
described in the 1980’s by Strobel
et al.
who
called them “ramp” lesions [4]. Increased
attention has been paid to this entity over the
last years [5, 6]. Among the arthroscopic
techniques, the all-inside repair through
standard anterior portal with meniscal suture
anchor devices implants has increased in
popularity because of its easy application [7].
However, complications have been reported
with these devices [8]. Biomechanically, the
horizontal sutures of these devices have inferior
strength compared to the vertical sutures [9].
Morgan described the vertical suture of the
posterior segment of the MM through a
posteromedial portal with a suture hook but
this technique fell out of favor possibly due it
being so technically demanding [10]. However
improved healing rate for posterior horn MM
lesions may be expected with better
visualization; allowing for an improved
diagnosis, an improved quality of the
debridement prior to the repair and the control
of a complete closure of the lesion through a
posteromedial portal with a simple vertical
suture [11].
The purpose of this article is to evaluate the
results of arthroscopic all-inside suture repair of
ramp lesions of the medial meniscus through a
posteromedialportalduringACLreconstruction.
We hypothesize that the technique of ar
throscopic vertical posterior suture through a
postero-medial portal with a suture hook device
for these peripheral and longitudinal posterior
tears of the MM encountered during ACL
reconstruction will provide clinical results at
least equal to other meniscal repair systemswith
no associated morbidity.
MATERIALAND METHODS
Patients
All patients who underwent a medial meniscal
repair with the Suture lasso device (Suture
lasso, Arthrex, Naples, FL) in conjunction with
primary or revision ACL reconstruction
betwesen October 1
st
2012 and March 15
th
2013
were entered into a prospective ACL re
construction database. The procedures were
performed by 3 senior surgeons. Inclusion
REPAIR OF MENISCAL RAMP
LESIONS THROUGH A
POSTEROMEDIAL PORTAL DURING
ACL RECONSTRUCTION: outcome
study with a minimum 2-year follow up
M. THAUNAT, N. JAN, J.M. FAYARD, C. KAJETANEK,
C.G. MURPHY, B. PUPIM, R. GARDON,
B. SONNERY-COTTET