Background:There is ongoing debate about the best way to manage ramp lesions at the time of anterior cruciate ligament (ACL) reconstruction (ACLR). Type 3 lesions are not visible by the transnotch approach without superior debridement, making the management debate even more problematic.Purpose/Hypothesis:The purpose of this study was to evaluate the rate of secondary surgical interventions according to the management method of a type 3 ramp lesion concomitant with primary ACLR. The hypothesis was that the rate of secondary ACL or meniscal interventions would be higher in patients who underwent all-inside repair.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective analysis of all patients who underwent primary ACLR with a type 3 ramp lesion between January 2012 and May 2020, regardless of the treatment method, was performed. The main criterion analyzed in this cohort was a secondary surgical intervention, defined as revision ACLR or a reintervention of the repaired meniscus. A survivorship analysis was performed to evaluate secondary surgical interventions in 3 groups: all-inside repair, suture hook repair, and left in situ. The following data were collected preoperatively and at the last follow-up: patient characteristics, time to surgery, side-to-side difference in laxity, pivot shift, Lysholm score, subjective International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, Tegner score, and meniscal repair failure rate.Results:A total of 113 patients who underwent type 3 ramp lesion repair concomitant with ACLR were included: 52 (46.0%) in the all-inside repair group, 23 (20.4%) in the suture hook repair group, and 38 (33.6%) in the lesion left in situ group. There were 17 patients (15.0%) who underwent a secondary intervention because of ACL graft failure (n = 6) or meniscal repair failure (n = 15 [4 of whom underwent a concomitant ACL reintervention]). Overall, 62 patients (54.9%) underwent combined ACLR and anterolateral ligament reconstruction, while 51 patients (45.1%) underwent isolated ACLR. In the adjusted Cox model, the type of meniscal repair was not statistically significantly associated with secondary surgical interventions. The only risk factor for secondary surgical interventions in this cohort was isolated ACLR (hazard ratio, 8.077; P = .007).Conclusion:The rates of secondary surgical interventions after medial meniscal type 3 ramp lesion repair concomitant with ACLR were similar regardless of the management method of the meniscal lesion. Despite not being associated with meniscal treatment, this rate was 8 times higher for patients who underwent isolated ACLR in this cohort; this is probably because of the protection that lateral extra-articular procedures provide to the ACL graft.

中文翻译：

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前交叉韧带重建中内侧半月板3型斜坡病变不同处理技术的临床效果：全内修复、缝线钩修复和原位病变的比较分析

背景：关于前交叉韧带 (ACL) 重建 (ACLR) 时处理坡道损伤的最佳方法一直存在争议。在没有高级清创的情况下，通过切迹入路无法看到 3 型病变，这使得管理争论更加成问题。 目的/假设：本研究的目的是根据 3 型坡道的管理方法评估二次手术干预的比率病变伴有原发性 ACLR。假设接受全内部修复的患者中二次 ACL 或半月板干预的发生率会更高。证据级别，3。方法：对 2012 年 1 月至 2020 年 5 月期间所有接受初次 ACLR 的 3 型斜坡病变患者进行回顾性分析，无论采用何种治疗方法。该队列分析的主要标准是二次手术干预，定义为 ACLR 翻修或修复半月板的再次干预。进行生存分析以评估 3 组的二次手术干预：全内部修复、缝合钩修复和留在原位。术前和最后一次随访时收集以下数据：患者特征、手术时间、松弛度的左右差异、枢轴移位、Lysholm 评分、国际膝关节文献委员会主观评分、膝关节损伤和骨关节炎结果评分、 Tegner评分、半月板修复失败率。结果：共纳入113例接受3型斜坡病变修复同时ACLR的患者：全内修复组52例（46.0%），缝合组23例（20.4%）。钩修复组38例（33.6%），病灶留在原位组38例（33.6%）。有 17 名患者 (15.0%) 由于 ACL 移植失败 (n = 6) 或半月板修复失败 (n = 15 [其中 4 人同时接受了 ACL 再次干预]) 接受了二次干预。总体而言，62 名患者（54.9%）接受了联合 ACLR 和前外侧韧带重建，而 51 名患者（45.1%）接受了单独 ACLR 重建。在调整后的 Cox 模型中，半月板修复的类型与二次手术干预没有统计学上的显着相关性。该队列中二次手术干预的唯一危险因素是孤立的 ACLR（风险比，8.077；P = .007）。 结论：内侧半月板 3 型斜坡病变修复伴随 ACLR 后二次手术干预的发生率相似，无论情况如何半月板病变的处理方法。尽管与半月板治疗无关，但该队列中接受单独 ACLR 治疗的患者的这一比率高出 8 倍；这可能是因为外侧关节外手术为 ACL 移植物提供了保护。