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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2018

21.06.2017 | Knee

Ramp lesions associated with ACL injuries are more likely to be present in contact injuries and complete ACL tears

verfasst von: Romain Seil, Caroline Mouton, Julien Coquay, Alexander Hoffmann, Christian Nührenbörger, Dietrich Pape, Daniel Theisen

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 4/2018

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Abstract

Purpose

The purpose of this study was to analyse patient and injury characteristics as well as arthroscopic findings in a prospective cohort of ACL-injured patients with or without an associated ramp lesion.

Methods

Two hundred and twenty-four patients undergoing a primary (n = 196) or revision (n = 28) ACL reconstruction were included. The presence of a ramp lesion was determined by a systematic arthroscopic inspection of the posteromedial compartment. Chi-square tests were used to compare the population of ACL-injured patients with and without a ramp lesion regarding sex, age, body mass index, previous ACL injuries, sport before injury, and injury characteristics. Significance was set at p < 0.05.

Results

Fifty-three out of 224 patients had a ramp lesion (24%). The presence of the latter was not related to any of the analysed patient characteristics. The prevalence of the lesion was higher in contact injuries (n = 19; 41%) compared with non-contact injures (n = 34; 19%; p < 0.001). It was higher in patients with complete ACL ruptures (n = 49; 27%) as opposed to partial ruptures (n = 1; 4%; p = 0.01). A patient was 2.98 [95% CI 1.49–5.98] times more likely to have a ramp lesion if the ACL injury was declared to have been caused by direct contact and 8.71 [95% CI 1.15–66.12] times more likely if the ACL tear was complete.

Conclusion

Ramp lesions may be anticipated in almost one out of four patients undergoing ACL reconstruction, especially if a patient sustained a contact injury and in the presence of a complete ACL tear.

Level of evidence

III.
Literatur
1.
Zurück zum Zitat Ahn JH, Kim SH, Yoo JC, Wang JH (2004) All-inside suture technique using two posteromedial portals in a medial meniscus posterior horn tear. Arthroscopy 20(1):101–108CrossRefPubMed Ahn JH, Kim SH, Yoo JC, Wang JH (2004) All-inside suture technique using two posteromedial portals in a medial meniscus posterior horn tear. Arthroscopy 20(1):101–108CrossRefPubMed
2.
Zurück zum Zitat Bisson LJ, Kluczynski MA, Hagstrom LS, Marzo JM (2013) A prospective study of the association between bone contusion and intra-articular injuries associated with acute anterior cruciate ligament tear. Am J Sports Med 41(8):1801–1807CrossRefPubMed Bisson LJ, Kluczynski MA, Hagstrom LS, Marzo JM (2013) A prospective study of the association between bone contusion and intra-articular injuries associated with acute anterior cruciate ligament tear. Am J Sports Med 41(8):1801–1807CrossRefPubMed
3.
Zurück zum Zitat Bollen SR (2010) Posteromedial meniscocapsular injury associated with rupture of the anterior cruciate ligament: a previously unrecognised association. J Bone Joint Surg Br 92(2):222–223CrossRefPubMed Bollen SR (2010) Posteromedial meniscocapsular injury associated with rupture of the anterior cruciate ligament: a previously unrecognised association. J Bone Joint Surg Br 92(2):222–223CrossRefPubMed
4.
Zurück zum Zitat 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(8 Suppl):S109–S118CrossRefPubMed 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(8 Suppl):S109–S118CrossRefPubMed
5.
Zurück zum Zitat DeFranco MJ, Bach BR Jr (2009) A comprehensive review of partial anterior cruciate ligament tears. J Bone Joint Surg Am 91(1):198–208CrossRefPubMed DeFranco MJ, Bach BR Jr (2009) A comprehensive review of partial anterior cruciate ligament tears. J Bone Joint Surg Am 91(1):198–208CrossRefPubMed
6.
Zurück zum Zitat 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(3):491–499CrossRefPubMed 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(3):491–499CrossRefPubMed
7.
Zurück zum Zitat Gillquist J, Hagberg G (1976) A new modification of the technique of arthroscopy of the knee joint. Acta Chir Scand 142(2):123–130PubMed Gillquist J, Hagberg G (1976) A new modification of the technique of arthroscopy of the knee joint. Acta Chir Scand 142(2):123–130PubMed
8.
Zurück zum Zitat Gillquist J, Hagberg G, Oretorp N (1979) Arthroscopic examination of the posteromedial compartment of the knee joint. Int Orthop 3(1):13–18CrossRefPubMed Gillquist J, Hagberg G, Oretorp N (1979) Arthroscopic examination of the posteromedial compartment of the knee joint. Int Orthop 3(1):13–18CrossRefPubMed
9.
Zurück zum Zitat Granan LP, Inacio MC, Maletis GB, Funahashi TT, Engebretsen L (2012) Intraoperative findings and procedures in culturally and geographically different patient and surgeon populations: an anterior cruciate ligament reconstruction registry comparison between Norway and the USA. Acta Orthop 83(6):577–582CrossRefPubMedPubMedCentral Granan LP, Inacio MC, Maletis GB, Funahashi TT, Engebretsen L (2012) Intraoperative findings and procedures in culturally and geographically different patient and surgeon populations: an anterior cruciate ligament reconstruction registry comparison between Norway and the USA. Acta Orthop 83(6):577–582CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat 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 Joint Surg Am 96(15):1233–1241CrossRefPubMedPubMedCentral 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 Joint Surg Am 96(15):1233–1241CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Janssen KW, Orchard JW, Driscoll TR, van Mechelen W (2012) High incidence and costs for anterior cruciate ligament reconstructions performed in Australia from 2003–2004 to 2007–2008: time for an anterior cruciate ligament register by Scandinavian model? Scand J Med Sci Sports 22(4):495–501CrossRefPubMed Janssen KW, Orchard JW, Driscoll TR, van Mechelen W (2012) High incidence and costs for anterior cruciate ligament reconstructions performed in Australia from 2003–2004 to 2007–2008: time for an anterior cruciate ligament register by Scandinavian model? Scand J Med Sci Sports 22(4):495–501CrossRefPubMed
12.
Zurück zum Zitat Levine JW, Kiapour AM, Quatman CE, Wordeman SC, Goel VK, Hewett TE et al (2013) Clinically relevant injury patterns after an anterior cruciate ligament injury provide insight into injury mechanisms. Am J Sports Med 41(2):385–395CrossRefPubMed Levine JW, Kiapour AM, Quatman CE, Wordeman SC, Goel VK, Hewett TE et al (2013) Clinically relevant injury patterns after an anterior cruciate ligament injury provide insight into injury mechanisms. Am J Sports Med 41(2):385–395CrossRefPubMed
13.
Zurück zum Zitat Lind M, Menhert F, Pedersen AB (2009) The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 17(2):117–124CrossRefPubMed Lind M, Menhert F, Pedersen AB (2009) The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 17(2):117–124CrossRefPubMed
14.
Zurück zum Zitat 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(4):832–837CrossRefPubMed 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(4):832–837CrossRefPubMed
15.
Zurück zum Zitat Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757CrossRefPubMed Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757CrossRefPubMed
16.
Zurück zum Zitat 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(10):2967–2973CrossRefPubMed 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(10):2967–2973CrossRefPubMed
17.
Zurück zum Zitat Rubin DA, Britton CA, Towers JD, Harner CD (1996) Are MR imaging signs of meniscocapsular separation valid? Radiology 201(3):829–836CrossRefPubMed Rubin DA, Britton CA, Towers JD, Harner CD (1996) Are MR imaging signs of meniscocapsular separation valid? Radiology 201(3):829–836CrossRefPubMed
18.
Zurück zum Zitat Seil R, Mouton C, Lion A, Nuhrenborger C, Pape D, Theisen D (2016) There is no such thing like a single ACL injury: profiles of ACL-injured patients. Orthop Traumatol Surg Res 102(1):105–110CrossRefPubMed Seil R, Mouton C, Lion A, Nuhrenborger C, Pape D, Theisen D (2016) There is no such thing like a single ACL injury: profiles of ACL-injured patients. Orthop Traumatol Surg Res 102(1):105–110CrossRefPubMed
19.
Zurück zum Zitat Seil R, VanGiffen N, Pape D (2009) Thirty years of arthroscopic meniscal suture: What’s left to be done? Orthop Traumatol Surg Res 95(8 Suppl 1):S85–S96CrossRefPubMed Seil R, VanGiffen N, Pape D (2009) Thirty years of arthroscopic meniscal suture: What’s left to be done? Orthop Traumatol Surg Res 95(8 Suppl 1):S85–S96CrossRefPubMed
20.
Zurück zum Zitat 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(4):921–926CrossRefPubMed 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(4):921–926CrossRefPubMed
21.
Zurück zum Zitat 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(2):400–408CrossRefPubMed 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(2):400–408CrossRefPubMed
Metadaten
Titel
Ramp lesions associated with ACL injuries are more likely to be present in contact injuries and complete ACL tears
verfasst von
Romain Seil
Caroline Mouton
Julien Coquay
Alexander Hoffmann
Christian Nührenbörger
Dietrich Pape
Daniel Theisen
Publikationsdatum
21.06.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 4/2018
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-017-4598-3

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