Abstract
Objectives:
The objective of this study was to develop a surgically relevant classification system for medial meniscus ramp tears by analyzing the tear morphology from a consecutive series of arthroscopic surgeries. The hypothesis was that a comprehensive and surgically intuitive classification system for ramp tears could be developed.
Methods:
A series of consecutive patients from two orthopedic surgeons (located in North America and Asia) between July 2021 to May 2024 with medial meniscus ramp tears were included in this multisite IRB-approved study. After arthroscopic confirmation of a medial meniscus ramp tear, the tear morphology and repair technique used was noted using a ramp tear diagram, operative notes, and surgical photos/videos. Tears were classified as partial or complete, stable or unstable, superior or inferior, and if they were in the capsule or within 3 mm of the medial meniscus rim. Stable or unstable meniscal ramp tears were classified based on arthroscopic probing. Stable ramp tears were tears that did not displace on arthroscopic probing; unstable tears were tears that displaced on arthroscopic probing. Complete ramp tears were tears either fully through the capsule or meniscus; partial ramp tears were tears that only affected either the superior or inferior meniscus or capsule. Additionally, the treatment method used for the ramp repair was noted.
Results:
A total of 115 patients with a mean age of 27.0 ± 9.7 years were included and grouped into five distinct groups based on ramp tear morphology (Table 1). Tears were subclassified as capsular (C, meniscocapsular/meniscotibial, Figure 1), meniscal (M, functionally a ramp tear; within 3 mm of the meniscus rim, Figure 2), and bucket-handle (B, Figure 2) type tears. Type 1 tears were partial stable tears (Type 1, N = 8, 7.0%), and were subclassified as either capsular based (Type 1C, N = 4, 3.5%) or meniscal based (Type 1M, N = 4, 3.5%). Type 2 tears were partial unstable femoral-sided tears (N = 8, 7.0%), and were subclassified as either meniscocapsular based (Type 2C, N = 7, 6.1%) or superior meniscal based (Type 2M, N = 1, 0.9%). Type 3 tears were partial unstable tibial-sided tears (N = 31, 27.0%), and were subclassified as either meniscotibial based (Type 3C, N = 23, 20.0%) or inferior meniscal based (Type 3M, N = 8, 7.0%). Type 4 tears were complete separation tears (N = 46, 40.0%), and were subclassified as capsular based (Type 4C, N = 37, 32.2%), meniscal based (Type 4M, N = 8, 7.0%), or bucket-handle tears (Type 4B, N = 1, 0.9%). Type 5 tears were complex or double tears of the meniscus and/or capsule (N = 22, 19.1%). Patient classification types are summarized in Table 2.
The treatment received by each patient varied based on tear type and surgical indications. An all-inside meniscus repair device was the most used technique, being used in 40.9% (N = 47) of patients and was typically used for smaller tears, usually for types 1-3. An inside-out ramp repair using vertical mattress sutures was used in 35.7% (N = 41) of patients. This repair technique was typically used in larger and more unstable tears (larger types 2 and 3 and most types 4 and 5) . An all-inside suture hook was used in 12.2% (N = 14) of patients, this was performed with an accessory posteromedial portal and was typically used for type 2 tears. A combination of an all-inside suture hook and an all-inside meniscus repair device was used in 8.7% (N = 10) of patients. This meniscus repair technique was typically used with type 4 and 5 tears with the suture hook used for superior tears and the all-inside meniscus repair device for the inferior portion of the ramp tears. No repair was required for 2.6% of patients (N = 3); these were all for type 1 tears.
Conclusions:
This study demonstrated that it was possible to establish a ramp tear classification system based on anatomic and arthroscopic morphological tear documentation. In the current study, ramp tears were grouped into five distinct groups: partial stable tears (Type 1), partial unstable superior tears (Type 2), partial unstable inferior tears (Type 3), complete separation tears (Type 4), and complex tears (Type 5). Overall, Type 3 and 4 tears were the most common tear patterns. This classification system allows for the ability to evaluate differing repair patterns and their effects on postoperative clinical outcomes.
