Ramp lesions of the medial meniscus are associated with greater preoperative anterior knee laxity in anterior cruciate ligament injury.

Abstract

Purpose: To assess the incidence of ramp lesions in anterior cruciate ligament (ACL) injuries and to compare preoperative knee laxity between the patients with and without ramp lesions by using an electromagnetic measurement system (EMS).

Methods: Two hundred six patients who underwent primary ACL reconstruction with preoperative EMS measurements were retrospectively enrolled in the present study. The diagnoses of the ramp lesions were made by arthroscopic inspections. The patients with ramp lesions and no other meniscal lesions were allocated to 'ramp group', and the patients without any meniscal lesions were allocated to 'control group'. Before ACL reconstruction under general anaesthesia, the side-to-side difference (SSD) in anterior tibial translation (ATT) during Lachman test (mm) and tibial acceleration (m/s²) of posterior tibial reduction during the pivot-shift test was measured using the EMS. The SSD in tibial internal/external rotation angle (°) at 30, 60 and 90 were further measured using the EMS. The SSD in ATT using KT-2000 was also measured. Knee laxity measurements were compared between two groups using unpaired Student's t test.

Results: Ramp lesions were observed in 30 patients (14.7%). Subsequently, 17 patients were allocated to 'ramp group' and 77 patients to 'control group', and there were no statistical differences with regard to background demographics. ATT-SSD during Lachman test was significantly greater in 'ramp group' (9.1 [95% confidence interval, CI: 5.7-12.5] mm vs. 6.2 [95% CI: 5.1-7.3] mm, p = 0.037). However, SSD in ATT with KT-2000, tibial acceleration during pivot-shift test, and SSD in tibial rotational angles were not significantly different between the two groups.

Conclusion: Presence of ramp lesion was associated with increased anterior knee laxity during Lachman test, suggesting ramp lesions may need to be addressed at the time of ACL reconstruction.

Level of evidence: IV.