{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T01:07:47Z","timestamp":1788743267639,"version":"build-2803163510"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate knee instability associated with combined ramp lesion and lateral meniscus posterior root tear (LMRT) in an anterior cruciate ligament (ACL)\u2010deficient knee (the new terrible triad).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Ten cadaveric knees were tested biomechanically. Internal rotation (IR), external rotation, and anterior tibial translation (ATT) were measured across 5 experimental conditions: intact, ACL\u2010deficient, ACL\u2010deficient with LMRT, ACL\u2010deficient with ramp lesion, and ACL\u2010deficient with combined LMRT and ramp lesion. Measurements were taken at knee flexion angles of 0\u00b0, 15\u00b0, 30\u00b0, 60\u00b0, and 90\u00b0 under 2\u2009Nm rotational torque and 88\u2009N anterior tibial load. IR and ATT were also measured during a simulated pivot\u2010shift maneuver at 0\u00b0, 15\u00b0, and 30\u00b0 flexion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In ACL\u2010deficient knee with combined ramp lesion and LMRT, IR was significantly increased compared with the intact, ACL\u2010deficient, and ACL\u2010deficient + LMRT at 0\u00b0, 15\u00b0, and 30\u00b0 flexion. External rotation was significantly greater in ACL\u2010deficient + LMRT + ramp lesion across all flexion angles. ATT was significantly higher in ACL\u2010deficient + LMRT + ramp lesion at 30\u00b0, 60\u00b0, and 90\u00b0 flexion. During the pivot\u2010shift test, IR in ACL\u2010deficient + LMRT + ramp lesion was significantly greater than in intact and ACL\u2010deficient at full extension and greater than in the ACL\u2010deficient + LMRT and ACL\u2010deficient + ramp lesion at 30\u00b0. Similarly, pivot\u2010shift ATT in ACL\u2010deficient + LMRT + ramp lesion was significantly greater than in intact and ACL\u2010deficient at full extension and greater than in intact at 30\u00b0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this time\u2010zero cadaveric study, an ACL\u2010deficient knee with combined LMRT and ramp lesion showed significantly greater anterior and rotational instability than ACL deficiency alone or ACL deficiency with either an isolated ramp lesion or an isolated LMRT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>These findings provide biomechanical insight into how combined ramp lesion and LMRT can exacerbate rotational instability in ACL\u2010deficient knees at time zero (cadaveric study).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/arj.70536","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:15:38Z","timestamp":1788740138000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined Ramp Lesion and Lateral Meniscus Root Tear Increase Rotational and Translational Instability in an Anterior Cruciate Ligament\u2010Deficient Knee: A Cadaveric Study"],"prefix":"10.1002","author":[{"given":"Yun Seong","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery Veterans Health Service Medical Center  Seoul Republic of Korea"},{"name":"Department of Orthopedic Surgery Seoul National University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanguang","family":"Piao","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Seoul National University College of 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