Morphological and functional variability of ramp lesions influences surgical management during anterior cruciate ligament reconstruction: A national registry study of the French Arthroscopic Society.
TL;DR
The Thaunat classification correlates with meniscal mobility and surgical strategy in this univariate analysis and may contribute to a more standardised, lesion-specific approach to the diagnosis and repair of ramp lesions during ACL reconstruction.
Abstract
Purpose
The purpose of this study was to describe current arthroscopic diagnostic and repair practices for ramp lesions during anterior cruciate ligament reconstruction and to evaluate the association between the Thaunat classification, meniscal mobility and surgical repair strategy.
Methods
A multicenter descriptive study was performed using data from the prospective French Arthroscopy Society registry. Patients undergoing anterior cruciate ligament reconstruction with an associated ramp lesion were included. Demographic data, mechanism of injury, delay to surgery, arthroscopic diagnostic technique, lesion type (Thaunat classification), meniscal mobility, lesion length, repair technique, number of sutures and surgical approach were recorded. Associations between lesion type, meniscal mobility and number of sutures were analysed.
Results
A total of 449 patients were included (69.3% male, mean age 25.4 ± 8.4 years). Sports trauma accounted for 91.5% of cases. Ramp lesion diagnosis was achieved primarily through intercondylar view alone (46.5%) or intercondylar view combined with posteromedial probing (41.9%). Lesion type according Thaunat were Type 1 (43.0%), Type 2 (7.8%), Type 3 (20.7%), Type 4 (21.2%) and Type 5 (7.3%). Meniscal mobility was pathological (defined as abnormal displacement of the posterior horn during probing without or with condylar overpass) in 79.7% of cases and a significant association was found between lesion type and pathological meniscal mobility (p < 0.01). Repair was with a posteromedial hook technique in 77.7%. Lesion type was significantly associated with the number of sutures (p < 0.01).
Conclusion
Ramp lesions demonstrate substantial morphological variability associated with different patterns of meniscal mobility. The Thaunat classification correlates with meniscal mobility and surgical strategy in this univariate analysis. Repair using a suture hook through a posteromedial portal remains the predominant technique in France. These findings may contribute to a more standardised, lesion-specific approach to the diagnosis and repair of ramp lesions during ACL reconstruction. LEVEL OF EVIDENCE Level III.