un stockage temporaire qui disparaît lorsque l'appareil s'éteint. 2. To better assess this region, a trans-notch approach is recommended because it provides better visualization of the posterior meniscocapsular junction. If left untreated, meniscal ramp lesions may contribute to residual anteroposterior instability in the anterior cruciate ligament–reconstructed knee and may also result in failure of meniscal repair. The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. There is no consensus on the exact definition of a meniscal ramp lesion. Ramp lesion classification as proposed by Thaunat and colleagues. This lack of prior importance attributed to the topic is likely a consequence of an underestimation of their incidence due to a high rate of missed diagnoses, insufficient knowledge about their biomechanical consequences, and an intuitive sense that these lesions could heal spontaneously. This close anatomic relationship between the semimembranosus tendon and the meniscocapsular region often can be visualized at the time of ramp repair ( Fig. Hatayama K, Terauchi M, Saito K, Aoki J, Nonaka S, Higuchi H. Magnetic Resonance Imaging Diagnosis of Medial Meniscal Ramp Lesions in Patients With Anterior Cruciate Ligament Injuries. tear populations.1 A ramp lesion involves tearing of the posteromedial meniscus at the meniscocap-sular junction and is of specific interest due to its reported ‘blind spot’ when viewing arthroscopically. Meniscal ramp lesions are a “hot topic” because of increasing recognition that they have important biomechanical consequences and also that they occur much more frequently than was previously understood. Arthroscopy is considered gold standard for diagnosis of ramp lesions. 6. Yujin Yeo, Joong Mo Ahn, Hyorin Kim, Yusuhn Kang, Eugene Lee, Joon Woo Lee, Heung Sik Kang. Ramp lesions are hypothesized to occur through a number of possible mechanisms. capsular and meniscotibial attachments of the PHMM, which may help provide a more precise definition of a meniscal ramp lesion. Despite this long history of recognition of ramp lesions, the topic has been infrequently studied over the past few decades, until a recent resurgence in interest. They can be difficult to identify if there is little or no posterior meniscocapsular tissue separation.Â. However, it is not without pitfalls. These reports are further supported with the work of numerous other investigators who have demonstrated that isolated ACL reconstruction fails to restore normal joint kinematics and results in residual laxity in the presence of a ramp lesion. Given the frequency of partial-thickness tears, they can be difficult to diagnose arthroscopically from the anterior compartment. Options for surgical treatment include arthroscopic repair using an all-inside or … The most simple is as a result of high forces transmitted through the posteromedial capsule during valgus strain, internal rotation of the tibia, and axial loading at the time of an anterior cruciate ligament (ACL) injury. Meniscal Ramp Lesions: Anatomy, Incidence, Diagnosis, and Treatment. Mobility at probing is low. Although these studies provide important information, they do not provide sufficient evidence to guide optimal treatment. Ramp lesions, whose name reflects the ramp-like appearance of the posteromedial zone, are a particular type of injury within the posterior horn of the medial meniscus and its meniscocapsular attachments [ 3 ]. Check for errors and try again. It is hypothesized that contraction of the semimembranosus, secondary to excessive anterior translation of the tibia during an ACL tear or the subsequent contrecoup mechanism may stress this posteromedial area, resulting in a meniscocapsular tear ± meniscotibial ligament injury and posteromedial instability. ramp lesion was defined as a longitudinal tear of the peripheral attachment of the posterior horn of the medial meniscus at the meniscocapsular junction of less than 2.5 cm in length.26 However, recent literature has sug-gested that ramp lesions are associated with injury to the meniscotibial ligament attachment of the posterior horn MR evaluation of the meniscal ramp lesion in patients with anterior cruciate ligament tear. Ramp. Originally, a ramp lesion was defined as a longitudinal tear of the peripheral attachment of the posterior horn of the medial meniscus at the meniscocapsular junction of less than 2.5 cm in length. Case 1: with anterior cruciate ligament tear, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity. This is used to pass a suture through the injured area, which is then tied with sliding knots (described later in this article). 2 ). The contemporary literature describes these injuries as tears at the posterior meniscocapsular junction and/or tears of the posterior meniscotibial ligament. In contrast, some surgeons have suggested that acute repair is necessary for ramp lesions because the capsular portion of the torn meniscus has a tendency to retract inferiorly, away from the tibial plateau, making it less likely for the tissue to heal spontaneously, thus requiring a specific posteromedial approach for the repair. A systematic exploration of the posteromedial compartment of the knee is mandatory to reliably identify ramp lesions. Pfirrmann. rescision pour lésion : définition juridique, références, actualité et les termes similaires. We describe a classification of the different types of ramp lesions depending on … The presence of any of these factors should raise the index of suspicion for the existence of a ramp lesion. This is of particular importance, because these missed tears are repairable. 47 (12): 1683. In 1988 Strobel characterised a particular type of meniscal injury associated with ACL rupture involving the peripheral attachment of the posterior horn of the medial meniscus (PHMM). Re-cent literature has extended the definition to include injuries of the meniscotibial ligament and peripheral lon-gitudinal tears in … (2011) The American Journal of Sports Medicine. Meniscal ramp lesions were studied by Hamberg and colleagues in the 1980s but at that time were described only as “injuries of the posterior aspect of the medial meniscus.” Later, Strobel introduced the term ramp lesion and characterized the injury as a longitudinal tear, 2.5 cm in length, located at the meniscocapsular junction. Pfirrmann. Recent epidemiologic data and definition of risk factors helps to inform an appropriate index of suspicion, identification, and adequate treatment of ramp lesions. There does not appear to be a consensus on the definition of a ramp lesion, beyond a tear of the far periphery of the posterior horn of the medial meniscus. The lesions are typically subtle or not immediately visible even with trans-notch visualization but can be strongly suggested by significant mobility on probing and also by identification of abnormal tissue quality on needling. This … Ramp lesions of the medial meniscus are commonly associated with anterior cruciate ligament ruptures and consist of longitudinal peripheral tears of the posterior horn of the medial meniscus. Temps 2 Voie Postéro Interne. However, most acute knee MRI evaluations are performed with the knee in full extension, which reduces the meniscocapsular gap, and can lead to false-negative tests. These lesions are very peripherally located in the synovial sheath. The most specific signs are complete thin linear fluid signal between the posterior horn of the medial meniscus and posteromedial capsule and posterior meniscal irregularity 3. DÉFINITION Deux critères positifs : • épisode traumatique causal entorse hyperflexiondouloureuse • Tissu méniscal sain IRM Evolution Traumatisme initial douloureux Puis épisodes de blocages douloureux / intervalles libres. 39 (4): 832-7. Understanding their nature, biomechanics, and epidemiology is essential in allowing orthopedic surgeons to suspect their presence and adequately treat these lesions. Type 3 : Partial inferior or hidden lesions. Arthroscopic trans-notch visualization of the posteromedial compartment of the left knee (* = posteromedial tibial plateau). 1 ). The most simple is as a result of high forces transmitted through the posteromedial capsule during valgus strain, internal rotation of the tibia, and axial loading at the time of … An important characteristic of the ramp lesion and one of the reasons why it has been underdiagnosed over the years is the difficulty in observing the tear via classic anterior portals, because the medial femoral condyle is located between the arthroscope and the posterior meniscocapsular junction, where it occurs. (, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Repair and InternalBrace Augmentation of the Medial Ulnar Collateral Ligament, Role of Alignment and Osteotomy in Meniscal Injuries, Evaluation and Treatment of Flexor Tendon and Pulley Injuries in Athletes, The Lacertus Syndrome of the Elbow in Throwing Athletes, Clinics in Sports Medicine Volume 39 Issue 1. still remains an understudied topic. The patient is positioned supine on the operating table with a tourniquet applied high on the thigh. 1. Ramp lesions by definition are associated with ACL tears and have a high incidence (40%) in various ACL tear populations.1 A ramp lesion involves tearing of the posteromedial meniscus at the meniscocapsular junction and is of specific interest due to its reported ‘blind spot’ when viewing arthroscopically. Detection at the time of arthroscopy can be accomplished based upon clinical suspicion and careful evaluation without the use of an accessory posteromedial portal. Although a ramp lesion may be suspected by increased mobility of the meniscus, it is essential to perform a direct visualization of the posterior meniscocapsular junction, because some of these tears (types I and II) may seem stable when inspected through anterior portals, even after probing. One of the most popular surgical techniques for treating meniscal ramp lesions is the use of a posteromedial portal suture hook device. Its name is derived from the arthroscopic appear-ance of a downwards slope or ramp and authors Chahla J, Dean CS, Moatshe G, Mitchell JJ, Cram TR, Yacuzzi C, LaPrade RF. Ramp Lesions (RL) are also often described as menisco-capsular separations and meniscosynovial tears [13]. (2020) Skeletal Radiology. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 1. meniscus.” Later, Strobel2 introduced the term ramp lesion and characterized the injury as a longitudinal tear, 2.5 cm in length, located at the meniscocapsular junction. If unstable, ramp lesions can be repaired arthroscopically 6.Â. Note the bone marrow edema pattern (dotted arrow). Xin Liu, Hua Feng, Hui Zhang, Lei Hong, Xue Song Wang, Jin Zhang. (2016) Orthopaedic journal of sports medicine. Ramp lesions are defined as a vertical (longitudinal) tear of the peripheral capsular attachment of the posterior horn of the medial meniscus at the meniscocapsular junction 1. Describe the diagnostic performance of MRI for detecting meniscal ramp lesion. (2018) Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. These lesions are stable and can be diagnosed only by a trans-notch approach. Forty percent of ramp lesions are not identified through standard anterior portal visualization and inspection of the posterior compartment via a trans-notch view, and posteromedial probing is required to identify them. RAMP LESION Voie Antéro Externe. Le larynx, grâce à sa position topographique et anatomique, peut être reconnu comme un 38 Regardless of the … past decade regarding meniscal ramp lesions. A meniscal ramp lesion was first described in 1983 by Hamberg et al., who reported this type of lesion during open surgical repair. Ramp lesions are hypothesized to occur through a number of possible mechanisms. A foot support is used to maintain the knee at 90° of flexion during the procedure, while allowing it to be manipulated through full range of motion, as needed ( Fig. Despite application of these techniques, the view of the peripheral area of the meniscus remains restricted. Failure to recognize and repair these injuries is associated with persistent anterior and posteromedial instability. Glossary of terms for musculoskeletal radiology. Meniscal ramp lesions occur much more frequently than was previously considered, and particularly so in ACL-injured knees. This is particularly true in varus knees and in those knees with a tight medial compartment. The ramp lesion is a disruption of the meniscotibial ligament and the posteromedial meniscus within the meniscocapsular zone. lesions by definition are associated with ACL tears. Peltier and colleagues concluded that these lesions appear to play a significant role in knee stability and also that ramp lesions increase the forces in the ACL. 34 (5): 1631-1637. The historically high rate of missed diagnoses is a result of unfamiliarity with this injury pattern within the orthopedic community, and also the difficulty in diagnosis.
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