Concurrent Repair of Medial Meniscal Ramp Lesions and Lateral Meniscus Root Tears in Patients Undergoing Anterior Cruciate Ligament Reconstruction: The "New Terrible Triad"

Christopher M LaPrade; Morgan D Homan; Jay Moran; Nicholas I Kennedy; Robert F LaPrade

doi:10.1016/j.eats.2023.04.028

Concurrent Repair of Medial Meniscal Ramp Lesions and Lateral Meniscus Root Tears in Patients Undergoing Anterior Cruciate Ligament Reconstruction: The "New Terrible Triad"

Arthrosc Tech. 2023 Aug 21;12(9):e1565-e1578. doi: 10.1016/j.eats.2023.04.028. eCollection 2023 Sep.

Authors

Christopher M LaPrade¹, Morgan D Homan², Jay Moran³, Nicholas I Kennedy², Robert F LaPrade²

Affiliations

¹ Stanford Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
² Twin Cities Orthopedics, Edina, Minnesota, U.S.A.
³ Yale School of Medicine, New Haven, Connecticut, U.S.A.

Abstract

Recent studies have suggested that up to 8% of patients with anterior cruciate ligament (ACL) tears can present with a combined medial meniscal ramp lesion (MMRL) and lateral meniscus root tear (LMRT). MMRLs and LMRTs often are missed preoperatively and can increase the risk of ACL graft failure if left untreated. Given the potential synergistic biomechanical consequences and challenging repair techniques used for treatment, our group commonly refers to this presentation (MMRL-LMRT-ACL) as the "new terrible triad" of ACL pathology. This Technical Note aims to describe a systematic approach for arthroscopic assessment and our preferred inside-out and transtibial pull-out repair techniques to efficiently diagnose and treat a combined MMRL and LMRT at the time of ACL reconstruction surgery.