Paper 12: Risk Factors and Failure Rates for Ramp Repair with ACL Reconstruction: An Analysis of 1037 Patients with a Mean Follow-up of 72 Months from the SANTI Study Group

Objectives: The primary objective of this study was to determine the failure rate (defined by secondary meniscectomy) of ramp repairs performed at the time of anterior cruciate ligament reconstruction (ACLR). The secondary objective was to investigate the association of patient and surgical characteristics with the risk of failure. Methods: A retrospective analysis of prospectively collected data was performed. All patients who underwent repair of a meniscal ramp lesion through a posteromedial portal at the time of primary ACLR, performed between January 2013 and December 2020, were considered for study eligibility. At the end of the study period, secondary meniscectomy rates were determined. Kaplan Meier analyses were used to evaluate repair survivorship. Risk factors associated with meniscal repair failure were analyzed using a logistic regression model. Results: 1037 patients were deemed eligible and included in the final analysis. The overall mean follow-up was 72.4 ± 27.1 months. The overall rate of secondary medial meniscectomy was 7.7%. Age, sex, Tegner score, and the duration of time between the injury and surgery were not found to be significant risk factors for secondary meniscectomy. The only significant risk factor for failure of ramp repair was the use of an isolated ACLR technique when compared to a combined ACLR + lateral extra-articular procedure (LEAP). The rate of secondary medial meniscectomy was 12.9% in the isolated ACLR group, compared to 4.8% in the combined ACLR + LEAP group (P< 0.0001). The odds of having a secondary medial meniscectomy were 62% lower for patients with combined ACLR + LEAP. Conclusions: At a mean follow-up of 72.4 months after ACLR + ramp repair, the failure rate was 7.7%. The failure rate was 2 times lower when a LEAP was performed in conjunction with ACLR. The only significant risk factor identified for failure of a ramp lesion was the use of an isolated ACLR instead of a combined ACLR + LEAP.