Incidence of Meniscal Ramp Lesion in Anterior Cruciate Ligament Reconstructions

Abreu, Felipe Galvão; Canuto, Sérgio Marinho de Gusmão; Canuto, Maira Macedo de Gusmão; Chagas, Eduardo Federighi; Zutin, Tereza Lais Menegucci; Pádua, Vitor Barion Castro de

doi:10.1055/s-0041-1735942

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Original Article • Rev. bras. ortop. 57 (3) • 2022 • https://doi.org/10.1055/s-0041-1735942 copy

Incidence of Meniscal Ramp Lesion in Anterior Cruciate Ligament Reconstructions^* * Work developed at Clínica Sportsmed, São José do Rio Preto, SP; at the Department of Orthopedics and Traumatology, Universidadede Marília, Marília, SP; and Ortoclínica Hospital de Ortopedia, Maceió, AL, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the incidence and epidemiological profile of meniscal ramp lesions in patients undergoing anterior cruciate ligament (ACL) reconstruction surgery, and to determine the related risk factors.

Methods

In total, 824 patients undergoing ACL reconstruction surgery were retrospectively analyzed. Patients who presented medial meniscal instability were submitted to evaluation of the posteromedial compartment of the knee. In case of injury, surgical repair was performed. Potential risk factors associated with the lesions were analyzed.

Results

The overall incidence of ramp lesions in the population studied was of 10.6% (87 lesions in 824 patients). The multivariate analysis through the Chi-squared test showed that the presence of meniscal ramp lesions was significantly associated with the following risk factors: right laterality and chronic lesions. Gender, age and sports activity were not statistically significant. Soccer was the most frequent cause of ramp injuries related to sport, with 78.2% of the cases. However, it was not shown to be a risk factor. The annual incidence from 2014 to 2019 ranged from 4.0% to 20.6%.

Conclusion

The incidence of meniscal ramp lesions was of 10.6% in ACL reconstruction surgeries, being more frequent among patients with chronic lesions. The increasing annual incidence ranged from 4.0% in 2014 to 20.6% in 2019.

Keywords
arthroscopy; epidemiology; knee; suture

Characteristics	With injury - n (%)	No injury - n (%)	p-value
Gender
Male	76 (87.3%)	631 (85.6%)	0.718
Female	11 (12.7%)	109 (14.4%)	0.718
Laterality
Right	61 (70.1%)	403 (54.7%)	0.008^{^*}
Left	26 (29.9%)	337 (45.3%)	0.008^{^*}
Ligament reconstruction
Primary	80 (91.9%)	694 (94.2%)	0.562
Revision	7 (8.1%)	43 (5.4%)	0.562
Age (years)
< 20	6 (6.9%)	102 (13.8%)	0.053
20-30	44 (50.6%)	267 (36.2%)
31-40	26 (29.9%)	255 (34.6%)
> 40	11 (12.6%)	119 (15.4%)
Average	29.9 (17-49)	31.4 (13-71)
Injury time (months)
< 3	28 (32.2%)	362 (49.1%)	0.008^{^*}
4-6	14 (16.1%)	102 (13.8%)
7-12	15 (17.2%)	79 (10.7%)
13-24	14 (16.1%)	58 (7.9%)
> 24	16 (18.4%)	136 (18.5%)
Average	16.4 (1-120)	19.7 (1-360)

Non-sport-related trauma	With injury - n (%)	No injury - n (%)	p-value
Fall	7 (5.9%)	64 (54.2%)	0.939
Traffic accident	4 (3.4%)	43 (36.5%)
Total (100%)	11 (9.3%)	107 (90.7%)
Sport-related trauma	With injury - n (%)	No injury - n (%)	p-value
Soccer	68 (9.6%)	548 (77.6%)	0.599
Wrestling	3 (0.4%)	25 (3.5%)
Basketball	1 (0.1%)	14 (2.0%)
Other	4 (0.7%)	43 (6.1%)
Total (100%)	76 (10.8%)	630 (89.2%)

Year	Total exposed (n)	Ramp lesion (n)	Incidence (%)	95%CI
Year	Total exposed (n)	Ramp lesion (n)	Incidence (%)	LL	UL
2014	124	5	4.00	1.70	9.10
2015	89	4	4.50	1.80	11.00
2016	110	12	10.90	6.40	18.10
2017	104	12	11.50	6.70	19.10
2018	116	6	5.20	2.40	10.80
2019	281	48	20.60	15.10	21.90
Total	824	87	10.60	8.60	12.80

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E-mail: rbo@sbot.org.br

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[1] Address for correspondence Felipe Galvão Abreu, MD, Av. Juscelino Kubitschek de Oliveira, 5.000, Sala 509, Complexo Iguatemi, São José do Rio Preto, SP, 15093-270, Brazil (e-mail: dr.felipegalvao@hotmail.com).