No influence of meniscal ramp lesion subtypes, stability and length on surgical repair outcomes: A 7–8 year follow‐up

Abstract Purpose This study aims to investigate the influence of ramp lesion subtype, stability and length on long‐term outcomes following their repair performed during anterior cruciate ligament (ACL) reconstruction, with revision surgery for meniscal repair failure as the primary outcome. Methods A retrospective review of 334 patients who underwent primary or revision ACL reconstruction with concomitant ramp lesion repair between November 2015 and November 2018. Exclusion criteria included concomitant reconstruction of other ligaments, high tibial osteotomy, more than two revision surgeries, traumatic ACL graft rupture before final follow‐up and use of all‐inside implants. Lesions were classified according to Thaunat's arthroscopic classification and measured for length. Revisions were defined as secondary meniscectomy or repeat repair unrelated to ACL graft rupture. Functional outcomes were assessed using International Knee Documentation Committee (IKDC) scores at final follow‐up. Results Out of 198 patients, 76.3% were male with a mean age of 29.3 (±9.3) years and mean body mass index (BMI) of 24.1 (±3.4). The majority of lesions were Type 1 (58.6%). Overall revision rate was 13.1% at a mean follow‐up of 90.3 months (±13.5). Revisions occurred predominantly in Type 4 (16.7%) and Type 5 (23.1%) lesions, whereas no revisions were recorded for Types 2 and 3. Stable (Types 1–2) and unstable (Types 3–5) lesions showed comparable revision rates (hazard ratio HR 1.5 95% confidence interval, CI: 0.7–3.3, p = 0.280). Lesions >1 cm suggest a higher hazard, but it was not statistically significant (HR 4.0 95% CI: 0.5–30.6, p = 0.179). The number of sutures did not influence outcomes ( p = 0.690). Mean IKDC score at final follow‐up was 57.4 ± 15.5. Conclusion Although ramp lesion subtype, lesion length and the number of sutures did not appear to influence revision rates, precise characterization based on lesion features remains necessary to better define the optimal management strategy, which continues to be debated. Level of Evidence Level IV, retrospective cohort study.