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Journals / Çukurova Anestezi ve Cerrahi Bilimler Dergisi / 2026 / Cilt: 9 Sayı: 3

Impact of Arthroscopes in the Diagnosis of the RAMP Lesion: 30° or 70° Arthroscope?

Artroskop Açılarının RAMP Lezyonu Tanısındaki Etkisi: 30° mu Yoksa 70° Artroskop mu?

Bahattin Kemah(University of Health Sciences, Umraniye Training and Research Hospital, Department of Orthopaedics and Traumatology)0000-0002-4795-4309
Emre Koraman(Department of Orthopaedics and Traumatology, Pendik Bolge Hospital, Istanbul,)0000-0003-2715-2875
Mehmet Akif Çaçan(İSTANBUL MEDİPOL ÜNİVERSİTESİ)0000-0003-2587-6327
Şafak Sayar(BİRUNİ ÜNİVERSİTESİ, BİRUNİ UYGULAMA VE ARAŞTIRMA MERKEZİ)0000-0003-1293-4436
Barış Gülenç0000-0002-4565-2315
Sercan Yalçın0000-0002-1310-068X
Mehmet Emin Erdil0000-0003-4637-9426
Pages
807–816
Publication Date
2026-09-30
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Incorporating a 70° arthroscope enhances visualization and diagnostic accuracy regardless of surgeon experience.

📌 3 Key Takeaways

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Objective & Hypothesis:Aim: This study compared the diagnostic accuracy of 30° and 70° arthroscopes used through standard anterior portals for detecting complete and partial ramp lesions of the medial meniscus during anterior cruciate ligament (ACL) reconstruction.
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Key Findings & Data:Materials and Methods: This prospective diagnostic accuracy study included 114 patients undergoing primary ACL reconstruction between August 2018 and August 2024, all with MRI findings suggestive of a ramp lesion.
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Conclusion & Impact:Incorporating a 70° arthroscope enhances visualization and diagnostic accuracy regardless of surgeon experience.
🔬Design:Araştırma Makalesi
📍Scope:2018 Verileri
⚙️Variables:Artroskopi · Diz yaralanmaları · Duyarlılık ve özgüllük

Abstract

Aim: This study compared the diagnostic accuracy of 30° and 70° arthroscopes used through standard anterior portals for detecting complete and partial ramp lesions of the medial meniscus during anterior cruciate ligament (ACL) reconstruction. Materials and Methods: This prospective diagnostic accuracy study included 114 patients undergoing primary ACL reconstruction between August 2018 and August 2024, all with MRI findings suggestive of a ramp lesion. Two senior surgeons (>20 years’ experience) and two junior surgeons (<5 years’ experience) independently evaluated the posteromedial compartment through the anterolateral portal using both arthroscopes in randomized order. Posteromedial portal inspection with probing served as the reference standard. Lesions were classified intraoperatively as complete or partial. Diagnostic accuracy, sensitivity, and interobserver agreement were calculated, and the effects of arthroscope angle, surgeon experience, and lesion subtype were analyzed using mixed-effects logistic regression. Results: Among 114 patients (mean age 26.8 years), 107 ramp lesions (79 complete, 28 partial) were confirmed. For senior surgeons, sensitivities were 72.9% and 69.2% with 30°, and 96.3% and 92.5% with 70° (p < 0.001). Junior surgeons achieved 57.9% and 53.3% with 30°, and 73.8% and 69.2% with 70° (p < 0.001). Mixed-effects analysis showed independent effects of angle (OR = 4.9, p < 0.001) and experience (OR = 2.3, p = 0.01), with a significant Angle × Type interaction (p = 0.04). Conclusion: Although arthroscopy remains the gold standard for diagnosing ramp lesions, using only a 30° arthroscope through the anterolateral portal may cause underdiagnosis, particularly of partial tears. Incorporating a 70° arthroscope enhances visualization and diagnostic accuracy regardless of surgeon experience.

Özet

Amaç: Bu çalışma, ön çapraz bağ (ÖÇB) rekonstrüksiyonu sırasında medial menisküsün tam ve kısmi ramp lezyonlarının saptanmasında, standart anterior portallerden kullanılan 30° ve 70° artroskopların tanısal doğruluğunu karşılaştırmıştır. Materyal ve Metot: Bu prospektif tanısal doğruluk çalışmasına, Ağustos 2018 ile Ağustos 2024 arasında primer ÖÇB rekonstrüksiyonu uygulanan ve tümünde MRG bulguları ramp lezyonunu düşündüren 114 hasta dahil edildi. İki kıdemli cerrah (>20 yıl deneyim) ve iki kıdemsiz cerrah (<5 yıl deneyim), posteromedial bölmeyi anterolateral portalden her iki artroskopu da rastgele sırayla kullanarak bağımsız olarak değerlendirdi. Bir kıdemli cerrah tarafından posteromedial portalden yapılan prob ile muayene referans standart olarak kabul edildi. Lezyonlar intraoperatif olarak tam veya kısmi şeklinde sınıflandırıldı. Tanısal doğruluk, duyarlılık ve gözlemciler arası uyum hesaplandı; artroskop açısı, cerrah deneyimi ve lezyon alt tipinin etkileri karma etkili lojistik regresyon ile analiz edildi. Bulgular: 114 hastada (ortalama yaş 26,8 yıl) 107 ramp lezyonu (79 tam, 28 kısmi) doğrulandı. Kıdemli cerrahlarda duyarlılık 30° ile %72,9 ve %69,2; 70° ile %96,3 ve %92,5 idi (p<0,001). Kıdemsiz cerrahlar 30° ile %57,9 ve %53,3; 70° ile %73,8 ve %69,2 değerlerine ulaştı (p<0,001). Karma etkili analizde açının (OR=4,9, p<0,001) ve deneyimin (OR=2,3, p=0,01) bağımsız etkileri saptandı; anlamlı bir Açı × Tip etkileşimi mevcuttu (p=0,04). Sonuç: Artroskopi ramp lezyonlarının tanısında altın standart olmaya devam etse de, anterolateral portalden yalnızca 30° artroskop kullanılması, özellikle kısmi yırtıklarda tanının atlanmasına yol açabilir. 70° artroskobun eklenmesi, cerrah deneyiminden bağımsız olarak görüntülemeyi ve tanısal doğruluğu artırır.

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Cite This Article

Kemah, B., Koraman, E., Çaçan, M. A., Sayar, Ş., Gülenç, B., Yalçın, S., Erdil, M. E. (2026). Impact of Arthroscopes in the Diagnosis of the RAMP Lesion: 30° or 70° Arthroscope?. Çukurova Anestezi ve Cerrahi Bilimler Dergisi, Cilt: 9 Sayı: 3, 807–816. https://doi.org/10.36516/jocass.1961982

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References (22)

  1. Kongmalai P, Chernchujit B. Posterior Horn of Medial Meniscal Peripheral Capsular Lesion: The Arthroscopic Repair Technique Working in the Posterior Compartment. Arthrosc Tech. 2016;5(4):e763-e767. doi:10.1016/j.eats.2016.03.001.
  2. Śmigielski R, Becker R, Zdanowicz U, Ciszek B. Medial meniscus anatomy-from basic science to treatment. Knee Surg Sports Traumatol Arthrosc. 2015;23(1):8-14. doi:10.1007/s00167-014-3476-5.
  3. Gülenç B, Kemah B, Yalçın S, Sayar Ş, Korkmaz O, Erdil M. Surgical Treatment of Meniscal RAMP Lesion. J Knee Surg. 2020;33(3):255-259. doi:10.1055/s-0039-1677887.
  4. Lorbach O, Kieb M, Herbort M, Weyers I, Raschke M, Engelhardt M. The influence of the medial meniscus in different conditions on anterior tibial translation in the anterior cruciate deficient knee. Int Orthop. 2015;39(4):681-687. doi:10.1007/s00264-014-2581-x.
  5. Stephen JM, Halewood C, Kittl C, Bollen SR, Williams A, Amis AA. Posteromedial Meniscocapsular Lesions Increase Tibiofemoral Joint Laxity With Anterior Cruciate Ligament Deficiency, and Their Repair Reduces Laxity. Am J Sports Med. 2016;44(2):400-408. doi:10.1177/0363546515617454.
  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(2):222-223. doi:10.1302/0301-620X.92B2.22974.
  7. 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(4):832-837. doi:10.1177/0363546510388933.
  8. Peltier A, Lording T, Maubisson L, Ballis R, Neyret P, Lustig S. The role of the meniscotibial ligament in posteromedial rotational knee stability. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):2967-2973. doi:10.1007/s00167-015-3751-0.
  9. Chahla J, Dean CS, Moatshe G, Mitchell JJ, Cram TR, Yacuzzi C, et al. Meniscal Ramp Lesions: Anatomy, Incidence, Diagnosis, and Treatment. Orthop J Sports Med. 2016;4(7):2325967116657815. doi:10.1177/2325967116657815.
  10. Chen Z, Li WP, Yang R, Song B, Jiang C, Hou JY, et al. Meniscal Ramp Lesion Repair Using the FasT-Fix Technique: Evaluating Healing and Patient Outcomes with Second-Look Arthroscopy. J Knee Surg. 2018;31(8):710-715. doi:10.1055/s-0037-1606378.
  11. 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. doi:10.1177/0363546517704426.
  12. Klein E, Solomon D. Editorial Commentary: Arthroscopy Is the Gold Standard for Diagnosis of Meniscal Ramp Lesions: Magnetic Resonance Imaging Also May Be Helpful. Arthroscopy. 2023;39(3):600-601. doi:10.1016/j.arthro.2022.12.007.
  13. Greif DN, Baraga MG, Rizzo MG, Mohile NV, Silva FD, Fox T, et al. MRI appearance of the different meniscal RAMP lesion types, with clinical and arthroscopic correlation. Skeletal Radiol. 2020;49(5):677-689. doi:10.1007/s00256-020-03381-4.
  14. Arner JW, Herbst E, Burnham JM, Soni A, Naendrup JH, Popchak A, et al. MRI can accurately detect meniscal RAMP lesions of the knee. Knee Surg Sports Traumatol Arthrosc. 2017;25(12):3955-3960. doi:10.1007/s00167-017-4523-9.
  15. Seil R, Mouton C, Coquay J, Hoffmann A, Nührenbörger C, Pape D, 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(4):1080-1085. doi:10.1007/s00167-017-4598-3.
  16. 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(4):921-926. doi:10.1177/0363546514522394.
  17. Liu X, Zhang H, Feng H, Hong L, Wang XS, Song GY. Is It Necessary to Repair Stable Ramp Lesions of the Medial Meniscus During Anterior Cruciate Ligament Reconstruction? A Prospective Randomized Controlled Trial. Am J Sports Med. 2017;45(5):1004-1011. doi:10.1177/0363546516682493.
  18. Thaunat M, Jan N, Fayard JM, Kajetanek C, Murphy CG, Pupim B, et al. Repair of Meniscal Ramp Lesions Through a Posteromedial Portal During Anterior Cruciate Ligament Reconstruction: Outcome Study With a Minimum 2-Year Follow-up. Arthroscopy. 2016;32(11):2269-2277. doi:10.1016/j.arthro.2016.02.026.
  19. Ahn JH, Kim SH, Yoo JC, Wang JH. All-inside suture technique using two posteromedial portals in a medial meniscus posterior horn tear. Arthroscopy. 2004;20(1):101-108. doi:10.1016/j.arthro.2003.11.008.
  20. Negrín R, Reyes NO, Iñiguez M, Pellegrini JJ, Wainer M, Duboy J. Meniscal Ramp Lesion Repair Using an All-Inside Technique. Arthrosc Tech. 2018;7(3):e265-e270. doi:10.1016/j.eats.2017.09.001.
  21. Buyukdogan K, Laidlaw MS, Miller MD. Meniscal Ramp Lesion Repair by a Trans-septal Portal Technique. Arthrosc Tech. 2017;6(4):e1379-e1386. doi:10.1016/j.eats.2017.05.029.
  22. Bae BS, Yoo S, Lee SH. Ramp lesion in anterior cruciate ligament injury: a review of the anatomy, biomechanics, epidemiology, and diagnosis. Knee Surg Relat Res. 2023;35(1):23. doi:10.1186/s43019-023-00197-z.