Ramp lesions are meniscocapsular or meniscosynovial tears associated with chronic ACL injury and are postulated to occur because of disruption of meniscotibial ligament. Various techniques have been described in literature for their diagnosis and repair. Each of the described techniques have had some concerns. The authors, hereby, describe a novel technique for RAMP repair. Patient is positioned supine with the knee at 90 degrees with a side support. Standard arthroscopic portals are established. Ramp lesions are visualised through a trans-notch approach and probed simultaneously using an 18-guage needle posteromedialy. Once the diagnosis has been confirmed a posteromedial (PM) portal is established. The edges of the tear are freshened from the PM portal using a shaver or rasp. Knee Scorpion device (Arthrex) is then introduced through the PM which is loaded with No. 0 Fibrewire (Arthrex) in its lower jaw. The Scorpion device is deployed on the capsular side first, avoiding injury to the posterior structures and the suture loop is retrieved. Scorpion is loaded again with the other strand and is passed through the meniscal edge. A sliding knot is used. Ramp lesion is re-probed after tying a sliding knot for requirement of another suture. This technique provides us with an improved visualisation and diagnosis, better quality of debridement and complete closure of the ramp lesion using a simple suture device. In our experience this is a safe, successful and easily reproducible technique.Abstract
Our Technique
Optimal management of acute patellar dislocation is still a topic of debate. Although, conventionally it has been managed by non-operative measures, recent literature recommends operative treatment to prevent re-dislocations. Our study recommends that results of non-operative measures comparable to that of operative management. Our study is the retrospective with 46 consecutive patients (47 knees) of first time patellar dislocation managed between 2012 and 2014. The study methodology highlighted upon the etiology, mechanism of injury and other characteristics of first time dislocations and also analysed outcomes of conservative management including re-dislocation rates. The duration of follow up ranged from 1 to 4 years. Average age at first-time dislocation was 23 years (Range 10–62 years). Male:Female ratio was 30:17. Twisting injury was the commonest cause. 1 patient required open reduction but all others relocated spontaneously or had successful closed reduction. Medial Patello-Femoral Ligament injury was frequent associated feature. 11 knees Conservative management of primary patellar dislocation is successful in majority of patients. Surgery should be reserved for the carefully selected patients with specific indications.
Meniscus deficiency leads to the development of early arthritis. Total knee replacement may be the only available treatment option in certain situations. However it is generally best avoided in young patients. We hypothesized that a combination of the two procedures, Allograft Meniscal Transplantation (AMT) and Autologous Chondrocyte Implantation (ACI) would be a solution to treat bone-on-bone arthritis in meniscal deficient knees and postpone the need for a total knee replacement (TKR). 12 consecutive patients who underwent both ACI and AMT between 1998 and 2005 were followed up prospectively. The patients were assessed by a self-assessed Lysholm score prior to the procedure and yearly thereafter. All operations were performed by the senior author (JBR). ACI procedure was performed according to the standard technique. Frozen meniscal allograft with bone plugs at either ends secured by sutures in the bone tunnels. Post operatively all patients underwent a strict Oscell Rehabilitation protocol. A repeat procedure or progression to a TKR was taken as a failure.Introduction
Materials/Methods
