Knie > Meniskus

Arthropedia – Grundlagenwissen und Fallbeispiele

19.08.2021 | Arthropedia | Online-Artikel

Update Wurzel- und Rampenläsionen

Was muss nun wie adressiert werden?

Meniskusverletzungen zählen zu den Hauptgründen der orthopädischen Konsultation [39]. Neben den am häufigsten auftretenden Längs- und Horizontalrissen handelt es sich bei Wurzel- und Rampenläsionen um spezielle Entitäten, welche sich in der Diagnostik, klinischen Auswirkung und auch der Therapie von herkömmlichen Meniskusrissen abheben [5, 18, 34, 37, 47]. Da es sich bei Wurzel- und Rampenläsionen um seltenere (aus Sicht der Autoren jedoch eher seltener geglaubte) und zugleich schwieriger zu behandelnde Verletzungsmuster handelt, wird ihnen oft weniger Beachtung geschenkt, was jedoch relevante klinische Auswirkungen nach sich zieht.

Literatur
  1. Achtnich A, Petersen W, Willinger L, Sauter A, Rasper M, Wörtler K et al (2018) Medial meniscus extrusion increases with age and BMI and is depending on different loading conditions. Knee Surg Sports Traumatol Arthrosc 26:2282–2288
    PubMed CrossRef

  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
    PubMed CrossRef

  3. Albayrak K, Buyukkuscu MO, Kurk MB, Kaya O, Kulduk A, Misir A (2021) Leaving the stable ramp lesion unrepaired does not negatively affect clinical and functional outcomes as well as return to sports rates after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. https://​doi.​org/​10.​1007/​s00167-020-06402-w
    CrossRef PubMed

  4. Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90:1922–1931
    PubMed CrossRef

  5. Bae JH, Paik NH, Park GW, Yoon JR, Chae DJ, Kwon JH et al (2013) Predictive value of painful popping for a posterior root tear of the medial meniscus in middle-aged to older Asian patients. Arthroscopy 29:545–549
    PubMed CrossRef

  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 28:3576–3586
    PubMed CrossRef

  7. Bernard CD, Kennedy NI, Tagliero AJ, Camp CL, Saris DBF, Levy BA et al (2020) Medial meniscus posterior root tear treatment: a matched cohort comparison of nonoperative management, partial meniscectomy, and repair. Am J Sports Med 48:128–132
    PubMed CrossRef

  8. Berthold DP, Muench LN, Herbst E, Mayr F, Chadayammuri V, Imhoff AB et al (2020) High prevalence of a deep lateral femoral notch sign in patients with anterior cruciate ligament (ACL) and concomitant posterior root tears of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc. https://​doi.​org/​10.​1007/​s00167-020-06071-9
    CrossRef PubMed

  9. Cavaignac E, Sylvie R, Teulières M, Fernandez A, Frosch KH, Gomez-Brouchet A et al (2020) What is the relationship between the distal semimembranosus tendon and the medial meniscus? A gross and microscopic analysis from the SANTI study group. Am J Sports Med. https://​doi.​org/​10.​1177/​0363546520980076​363546520980076
    CrossRef PubMed

  10. Chen Z, Li WP, Yang R, Song B, Jiang C, Hou JY et al (2018) Meniscal ramp lesion repair using the FasT-fix technique: evaluating healing and patient outcomes with second-look arthroscopy. J Knee Surg 31:710–715
    PubMed CrossRef

  11. Chung KS, Ha JK, Yeom CH, Ra HJ, Jang HS, Choi SH et al (2015) Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: a minimum 5‑year follow-up. Arthroscopy 31:1941–1950
    PubMed CrossRef

  12. DePhillipo NN, Cinque ME, Chahla J, Geeslin AG, Engebretsen L, LaPrade RF (2017) Incidence and detection of meniscal ramp lesions on magnetic resonance imaging in patients with anterior cruciate ligament reconstruction. Am J Sports Med 45:2233–2237
    PubMed CrossRef

  13. DePhillipo NN, Dornan GJ, Dekker TJ, Aman ZS, Engebretsen L, LaPrade RF (2020) Clinical characteristics and outcomes after primary ACL reconstruction and meniscus ramp repair. Orthop J Sports Med 8:2325967120912427
    PubMed PubMedCentral

  14. 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
    PubMed CrossRef

  15. DePhillipo NN, Moatshe G, Chahla J, Aman ZS, Storaci HW, Morris ER et al (2019) Quantitative and qualitative assessment of the posterior medial meniscus anatomy: defining meniscal ramp lesions. Am J Sports Med 47:372–378
    PubMed CrossRef

  16. Diermeier T, Beitzel K, Bachmann L, Petersen W, Esefeld K, Wörtler K et al (2019) Mountain ultramarathon results in temporary meniscus extrusion in healthy athletes. Knee Surg Sports Traumatol Arthrosc 27:2691–2697
    PubMed CrossRef

  17. Dragoo JL, Konopka JA, Guzman RA, Segovia N, Kandil A, Pappas GP (2020) Outcomes of arthroscopic all-inside repair versus observation in older patients with meniscus root tears. Am J Sports Med 48:1127–1133
    PubMed CrossRef

  18. Fetzer GB, Spindler KP, Amendola A, Andrish JT, Bergfeld JA, Dunn WR et al (2009) Potential market for new meniscus repair strategies: evaluation of the MOON cohort. J Knee Surg 22:180–186
    PubMed PubMedCentral CrossRef

  19. Feucht MJ, Izadpanah K, Lacheta L, Südkamp NP, Imhoff AB, Forkel P (2019) Arthroscopic transtibial pullout repair for posterior meniscus root tears. Oper Orthop Traumatol 31:248–260
    PubMed CrossRef

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

  21. Foreman SC, Liu Y, Nevitt MC, Neumann J, Joseph GB, Lane NE et al (2020) Meniscal root tears and extrusion are significantly associated with the development of accelerated knee osteoarthritis: data from the osteoarthritis initiative. CARTILAGE. https://​doi.​org/​10.​1177/​1947603520934525​1947603520934525​
    CrossRef PubMed

  22. 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
    PubMed CrossRef

  23. 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
    PubMed CrossRef

  24. 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
    PubMed PubMedCentral

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

  26. 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
    CrossRef

  27. Han SB, Shetty GM, Lee DH, Chae DJ, Seo SS, Wang KH et al (2010) Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5– to 8‑year follow-up study. Arthroscopy 26:1326–1332
    PubMed CrossRef

  28. Hatayama K, Terauchi M, Saito K, Aoki J, Nonaka S, Higuchi H (2018) Magnetic resonance imaging diagnosis of medial meniscal ramp lesions in patients with anterior cruciate ligament injuries. Arthroscopy 34:1631–1637
    PubMed CrossRef

  29. Keyhani S, Ahn JH, Verdonk R, Soleymanha M, Abbasian M (2017) Arthroscopic all-inside ramp lesion repair using the posterolateral transseptal portal view. Knee Surg Sports Traumatol Arthrosc 25:454–458
    PubMed CrossRef

  30. Kim SH, Seo HJ, Seo DW, Kim KI, Lee SH (2020) Analysis of risk factors for ramp lesions associated with anterior cruciate ligament injury. Am J Sports Med 48:1673–1681
    PubMed CrossRef

  31. Krych AJ, Bernard CD, Kennedy NI, Tagliero AJ, Camp CL, Levy BA et al (2020) Medial versus lateral meniscus root tears: is there a difference in injury presentation, treatment decisions, and surgical repair outcomes? Arthroscopy 36:1135–1141
    PubMed CrossRef

  32. Krych AJ, LaPrade MD, Hevesi M, Rhodes NG, Johnson AC, Camp CL et al (2020) Investigating the chronology of meniscus root tears: do medial meniscus posterior root tears cause extrusion or the other way around? Orthop J Sports Med 8:2325967120961368
    PubMed PubMedCentral

  33. LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF (2015) Meniscal root tears: a classification system based on tear morphology. Am J Sports Med 43:363–369
    PubMed CrossRef

  34. LaPrade RF, Ho CP, James E, Crespo B, LaPrade CM, Matheny LM (2015) Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology. Knee Surg Sports Traumatol Arthrosc 23:152–157
    PubMed CrossRef

  35. Lee DW, Lee SH, Kim JG (2020) Outcomes of medial meniscal posterior root repair during proximal tibial osteotomy: is root repair beneficial? Arthroscopy 36:2466–2475
    PubMed CrossRef

  36. Lee JY, Chia ZY, Jiang L, Ang B, Chang P (2020) A review of the Gillquist maneuver: modifications for a safer and easily reproducible approach for knee transintercondylar notch posterior compartment Arthroscopy. Arthrosc Tech 9:e435–e438
    PubMed PubMedCentral CrossRef

  37. 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
    PubMed CrossRef

  38. Liu X, Zhang H, Feng H, Hong L, Wang XS, Song GY (2017) Is it necessary to repair stable ramp lesions of the medial meniscus during anterior cruciate ligament reconstruction? A prospective randomized controlled trial. Am J Sports Med 45:1004–1011
    PubMed CrossRef

  39. Majewski M, Susanne H, Klaus S (2006) Epidemiology of athletic knee injuries: A 10-year study. Knee 13:184–188
    PubMed CrossRef

  40. Masouros SD, McDermott ID, Amis AA, Bull AM (2008) Biomechanics of the meniscus-meniscal ligament construct of the knee. Knee Surg Sports Traumatol Arthrosc 16:1121–1132
    PubMed CrossRef

  41. Moon HK, Koh YG, Kim YC, Park YS, Jo SB, Kwon SK (2012) Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med 40:1138–1143
    PubMed CrossRef

  42. Moon HS, Choi CH, Jung M, Lee DY, Hong SP, Kim SH (2020) Early surgical repair of medial meniscus posterior root tear minimizes the progression of meniscal extrusion: 2‑year follow-up of clinical and radiographic parameters after Arthroscopic Transtibial pull-out repair. Am J Sports Med 48:2692–2702
    PubMed CrossRef

  43. Mouton C, Magosch A, Pape D, Hoffmann A, Nührenbörger 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
    PubMed CrossRef

  44. Naendrup JH, Pfeiffer TR, Chan C, Nagai K, Novaretti JV, Sheean AJ et al (2019) Effect of meniscal ramp lesion repair on knee kinematics, bony contact forces, and in situ forces in the anterior cruciate ligament. Am J Sports Med 47:3195–3202
    PubMed PubMedCentral CrossRef

  45. Okazaki Y, Furumatsu T, Kamatsuki Y, Okazaki Y, Masuda S, Hiranaka T et al (2020) Transtibial pullout repair of the lateral meniscus posterior root tear combined with anterior cruciate ligament reconstruction reduces lateral meniscus extrusion: A retrospective study. Orthop Traumatol Surg Res 106:469–473
    PubMed CrossRef

  46. Schillhammer CK, Werner FW, Scuderi MG, Cannizzaro JP (2012) Repair of lateral meniscus posterior horn detachment lesions: a biomechanical evaluation. Am J Sports Med 40:2604–2609
    PubMed CrossRef

  47. Seil R, Mouton C, Coquay J, Hoffmann A, Nührenbörger 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

  48. 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
    PubMed CrossRef

  49. Song GY, Zhang H, Liu X, Zhang J, Xue Z, Qian Y et al (2017) Complete posterolateral meniscal root tear is associated with high-grade pivot-shift phenomenon in noncontact anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 25:1030–1037
    PubMed CrossRef

  50. 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
    PubMed CrossRef

  51. Stephen JM, Halewood C, Kittl C, Bollen SR, Williams A, Amis AA (2016) Posteromedial meniscocapsular lesions increase tibiofemoral joint laxity with anterior cruciate ligament deficiency, and their repair reduces laxity. Am J Sports Med 44:400–408
    PubMed CrossRef

  52. Tang X, Marshall B, Wang JH, Zhu J, Li J, Smolinski P et al (2019) Lateral meniscal posterior root repair with anterior cruciate ligament reconstruction better restores knee stability. Am J Sports Med 47:59–65
    PubMed CrossRef

  53. Tashiro Y, Mori T, Kawano T, Oniduka T, Arner JW, Fu FH et al (2020) Meniscal ramp lesions should be considered in anterior cruciate ligament-injured knees, especially with larger instability or longer delay before surgery. Knee Surg Sports Traumatol Arthrosc 28:3569–3575
    PubMed CrossRef

  54. 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
    PubMed PubMedCentral CrossRef

  55. Thaunat M, Jan N, Fayard JM, Kajetanek C, Murphy CG, Pupim B et al (2016) Repair of meniscal ramp lesions through a posteromedial portal during anterior cruciate ligament reconstruction: outcome study with a minimum 2‑year follow-up. Arthroscopy 32:2269–2277
    PubMed CrossRef

  56. Waldt S (2013) Meniskus-update. Radiol Up2date 13:285–304
    CrossRef

  57. Willinger L, Lang JJ, von Deimling C, Diermeier T, Petersen W, Imhoff AB et al (2020) Varus alignment increases medial meniscus extrusion and peak contact pressure: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 28:1092–1098
    PubMed CrossRef

  58. Winkler PW, Csapo R, Wierer G, Hepperger C, Heinzle B, Imhoff AB et al (2020) Sonographic evaluation of lateral meniscal extrusion: implementation and validation. Arch Orthop Trauma Surg. https://​doi.​org/​10.​1007/​s00402-020-03683-1
    CrossRef PubMed PubMedCentral

  59. Winkler PW, Wierer G, Csapo R, Hepperger C, Heinzle B, Imhoff AB et al (2020) Quantitative evaluation of dynamic lateral meniscal extrusion after radial tear repair. Orthop J Sports Med 8:2325967120914568
    PubMed PubMedCentral

  60. Zhuo H, Pan L, Xu Y, Li J (2020) Functional, magnetic resonance imaging, and second-look arthroscopic outcomes after pullout repair for avulsion tears of the posterior lateral meniscus root. Am J Sports Med. https://​doi.​org/​10.​1177/​0363546520976635​363546520976635
    CrossRef PubMed