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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(03): 422-428
DOI: 10.1055/s-0041-1735942
Artigo Original

Incidência de lesões da rampa meniscal nas reconstruções do ligamento cruzado anterior[*]

Article in several languages: português | English
Felipe Galvão Abreu 
1   Clínica Sportsmed, São José do Rio Preto, SP, Brasil
,
Sérgio Marinho de Gusmão Canuto 
2   Ortoclínica Hospital de Ortopedia, Maceió, AL, Brasil
,
Maira Macedo de Gusmão Canuto 
2   Ortoclínica Hospital de Ortopedia, Maceió, AL, Brasil
,
Eduardo Federighi Chagas 
3   Departamento de Educação Física da Universidade de Marília, Marília, SP, Brasil
,
Tereza Lais Menegucci Zutin 
4   Departamento de Ortopedia e Traumatologia, Universidade de Marília, Marília, SP, Brasil
,
Vitor Barion Castro de Pádua 
4   Departamento de Ortopedia e Traumatologia, Universidade de Marília, Marília, SP, Brasil
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Resumo

Objetivo Avaliar a incidência e o perfil epidemiológico das lesões da rampa meniscal nos pacientes submetidos a cirurgia de reconstrução do ligamento cruzado anterior (LCA), e determinar os fatores de risco relacionados.

Métodos Foram analisados retrospectivamente 824 pacientes submetidos a cirurgia de reconstrução do LCA. Os pacientes que apresentaram instabilidade meniscal medial foram submetidos a avaliação do compartimento posteromedial do joelho. Em caso de lesão, o reparo cirúrgico foi realizado. Potenciais fatores de risco associados às lesões foram analisados.

Resultados A incidência geral de lesões da rampa na população estudada foi de 10,6% (87 lesões em 824 pacientes). A análise multivariada pelo teste do Qui-quadrado demonstrou que a presença de lesões da rampa meniscal foi significativamente associada aos seguintes fatores de risco: lateralidade direita e lesões crônicas. Sexo, idade e atividade esportiva não foram estatisticamente significantes. O futebol foi a causa mais frequente de lesões da rampa relacionadas ao esporte, com 78,2% dos casos. No entanto, não se mostrou ser um fator de risco. De 2014 a 2019, a incidência anual variou de 4,0% a 20,6%.

Conclusão A incidência das lesões da rampa meniscal foi de 10,6% nas cirurgias de reconstrução do LCA, sendo mais frequente em pacientes com lesões crônicas. A incidência anual foi crescente, e variou de 4,0%, em 2014, a 20,6%, em 2019.

Palavras-chave

artroscopia - epidemiologia - joelho - sutura

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* Trabalho desenvolvido na Clínica Sportsmed, São José do Rio Preto, SP; no Departamento de Ortopedia e Traumatologia da Universidade de Marília, Marília, SP; e na Ortoclínica Hospital de Ortopedia, Maceió, AL, Brasil.




Publication History

Received: 04 December 2020

Accepted: 02 June 2021

Article published online:
20 January 2022

© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Sonnery-Cottet B, Praz C, Rosenstiel N. et al. Epidemiological Evaluation of Meniscal Ramp Lesions in 3214 Anterior Cruciate Ligament-Injured Knees From the SANTI Study Group Database: A Risk Factor Analysis and Study of Secondary Meniscectomy Rates Following 769 Ramp Repairs. Am J Sports Med 2018; 46 (13) 3189-3197
    CrossrefPubMedGoogle Scholar
  • 2 Mouton C, Magosch A, Pape D, Hoffmann A, Nührenbörger C, Seil R. Ramp lesions of the medial meniscus are associated with a higher grade of dynamic rotatory laxity in ACL-injured patients in comparison to patients with an isolated injury. Knee Surg Sports Traumatol Arthrosc 2020; 28 (04) 1023-1028
    CrossrefPubMedGoogle Scholar
  • 3 Sonnery-Cottet B, Serra Cruz R, Vieira TD, Goes RA, Saithna A. Ramp Lesions: An Unrecognized Posteromedial Instability?. Clin Sports Med 2020; 39 (01) 69-81
    CrossrefPubMedGoogle Scholar
  • 4 Ahn JH, Bae TS, Kang KS, Kang SY, Lee SH. Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability. Am J Sports Med 2011; 39 (10) 2187-2193
    CrossrefPubMedGoogle Scholar
  • 5 Strobel MJ. Menisci. In: Fett HM, Flechtner P. eds. Manual of Arthroscopy Surgery. New York: Springer; 1988: 171-178
    Google Scholar
  • 6 Bollen SR. Posteromedial meniscocapsular injury associated with rupture of the anterior cruciate ligament: a previously unrecognised association. J Bone Joint Surg Br 2010; 92 (02) 222-223
    CrossrefPubMedGoogle Scholar
  • 7 Chahla J, Dean CS, Moatshe G. et al. Meniscal Ramp Lesions: Anatomy, Incidence, Diagnosis, and Treatment. Orthop J Sports Med 2016; 4 (07) 2325967116657815
    CrossrefPubMedGoogle Scholar
  • 8 Sonnery-Cottet B, Conteduca J, Thaunat M, Gunepin FX, Seil R. Hidden lesions of the posterior horn of the medial meniscus: a systematic arthroscopic exploration of the concealed portion of the knee. Am J Sports Med 2014; 42 (04) 921-926
    CrossrefPubMedGoogle Scholar
  • 9 DePhillipo NN, Cinque ME, Chahla J, Geeslin AG, Engebretsen L, LaPrade RF. Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance Imaging in Patients With Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2017; 45 (10) 2233-2237
    CrossrefPubMedGoogle Scholar
  • 10 Liu X, Feng H, Zhang H, Hong L, Wang XS, Zhang J. Arthroscopic prevalence of ramp lesion in 868 patients with anterior cruciate ligament injury. Am J Sports Med 2011; 39 (04) 832-837
    CrossrefPubMedGoogle Scholar
  • 11 Thaunat M, Fayard JM, Guimaraes TM, Jan N, Murphy CG, Sonnery-Cottet B. Classification and Surgical Repair of Ramp Lesions of the Medial Meniscus. Arthrosc Tech 2016; 5 (04) e871-e875
    CrossrefPubMedGoogle Scholar
  • 12 Garofalo R, Mouhsine E, Chambat P, Siegrist O. Anatomic anterior cruciate ligament reconstruction: the two-incision technique. Knee Surg Sports Traumatol Arthrosc 2006; 14 (06) 510-516
    CrossrefPubMedGoogle Scholar
  • 13 de Pádua VB, Maldonado H, Vilela JC, Provenza AR, Monteiro C, de Oliveira Neto HC. Comparative study of ACL reconstruction with anatomical positioning of the tunnels using the patellar tendon versus hamstrings tendon. Rev Bras Ortop 2015; 47 (01) 50-56
    Google Scholar
  • 14 Seil R, Mouton C, Coquay J. et al. Ramp lesions associated with ACL injuries are more likely to be present in contact injuries and complete ACL tears. Knee Surg Sports Traumatol Arthrosc 2018; 26 (04) 1080-1085
    PubMedGoogle Scholar
  • 15 Di Vico G, Di Donato SL, Balato G. et al. Correlation between time from injury to surgery and the prevalence of ramp and hidden lesions during anterior cruciate ligament reconstruction. A new diagnostic algorithm. Muscles Ligaments Tendons J 2018; 7 (03) 491-497
    CrossrefPubMedGoogle Scholar
  • 16 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. Arthroscopy 2018; 34 (05) 1631-1637
    CrossrefPubMedGoogle Scholar
  • 17 Sonnery-Cottet B. Editorial Commentary: Ramp Lesion: The Eye Sees Only What the Mind Is Prepared to Comprehend. Arthroscopy 2020; 36 (11) 2934-2937
    CrossrefPubMedGoogle Scholar
  • 18 Rochcongar G, Cucurulo T, Ameline T. et al. Meniscal survival rate after anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 2015; 101 (8, Suppl) S323-S326
    CrossrefPubMedGoogle Scholar
  • 19 Woods GW, Chapman DR. Repairable posterior menisco-capsular disruption in anterior cruciate ligament injuries. Am J Sports Med 1984; 12 (05) 381-385
    CrossrefPubMedGoogle Scholar
  • 20 Kennedy J, Jackson MP, O'Kelly P, Moran R. Timing of reconstruction of the anterior cruciate ligament in athletes and the incidence of secondary pathology within the knee. J Bone Joint Surg Br 2010; 92 (03) 362-366
    CrossrefPubMedGoogle Scholar
  • 21 Church S, Keating JF. Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Joint Surg Br 2005; 87 (12) 1639-1642
    CrossrefPubMedGoogle Scholar
  • 22 Drogset JO, Grøntvedt T. Anterior cruciate ligament reconstruction with and without a ligament augmentation device : results at 8-Year follow-up. Am J Sports Med 2002; 30 (06) 851-856
    CrossrefPubMedGoogle Scholar
  • 23 George MS, Dunn WR, Spindler KP. Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 2006; 34 (12) 2026-2037
    CrossrefPubMedGoogle Scholar
  • 24 Brophy RH, Haas AK, Huston LJ, Nwosu SK, Wright RW. MARS Group. Association of Meniscal Status, Lower Extremity Alignment, and Body Mass Index With Chondrosis at Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2015; 43 (07) 1616-1622
    CrossrefPubMedGoogle Scholar
  • 25 Wright RW, Huston LJ, Spindler KP. et al. Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort. Am J Sports Med 2010; 38 (10) 1979-1986
    CrossrefPubMedGoogle Scholar