Diagnostic Performance of Magnetic Resonance Imaging for Detecting Meniscal Ramp Lesions in Patients With Anterior Cruciate Ligament Tears: A Systematic Review and Meta-analysis

Abstract

Background: The clinical importance of meniscal ramp lesions in patients with anterior cruciate ligament (ACL) tear has emerged as a major issue. However, the diagnostic accuracy of magnetic resonance imaging (MRI) for detecting ramp lesions has a wide range. Purpose: To perform a systematic review and meta-analysis of the diagnostic performance of MRI for diagnosing ramp lesion in patients with ACL tear. Study Design: Systematic review and meta-analysis. Methods: A literature search of PubMed, EMBASE, and the Cochrane Library was performed based on the revised guidelines for the PRISMA DTA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Accuracy Studies) statement. Diagnostic performance studies using MRI as the index test and arthroscopy as the reference standard for ramp lesion were included. Bivariate and hierarchical summary receiver operating characteristic modeling was used to evaluate the diagnostic performance. Meta-regression analyses were performed to identify potential sources of heterogeneity. Results: The review and meta-analysis included 9 studies from 8 articles (883 patients with ACL tear and reconstruction). The summary sensitivity, summary specificity, and area under the hierarchical summary receiver operating characteristic for ramp lesion were 0.71 (95% CI, 0.59-0.81), 0.94 (95% CI, 0.88-0.97), and 0.90 (95% CI, 0.87-0.92), respectively. Among the potential covariates, magnet strength ( P < .01), patient knee position ( P = .04), and MRI interpreter ( P = .04) were associated with heterogeneity in terms of sensitivity, whereas magnet strength ( P = .03) was associated with heterogeneity in terms of specificity. Conclusion: MRI demonstrated moderate sensitivity and excellent specificity for diagnosing ramp lesion. Routine arthroscopic assessment is recommended for the presence of ramp lesion, regardless of whether it is suspected on MRI. Further clinicoradiological studies of diagnostic algorithms are needed for identifying ramp lesion, including high-resolution MRI with appropriate knee position.

Prevalence and Detection of Meniscal Ramp Lesions in Pediatric Anterior Cruciate Ligament–Deficient Knees

“…Diagnosing ramp lesions by imaging is exceedingly difficult, with an average MRI sensitivity of 71% according to a recent meta-analysis. 6 Malatray et al 9 reported a sensitivity of only 23.2% using MRI in their pediatric study. Meniscal vascularization in children can generate false-positive cases.…”

“…MRI sensitivity may well have been improved with 3-T instead of 1.5-T magnet machines. 6 Finally, there was a variable interval between the preoperative MRI and the surgery, allowing for either further meniscal tears or spontaneous healing in this time frame, depending on the case.…”

Analysis of Risk Factors for Ramp Lesions Associated With Anterior Cruciate Ligament Injury

“…However, the predicted diagnostic values by the logistic regression equation were an AUC of 0.779, a sensitivity to detect ramp lesions of 75.8%, and a specificity of 71.7%, which were comparable with MRI values, although MRI values were somewhat higher. 2,21,23 The diagnostic values were calculated regardless of the direct positive findings of ramp lesions on MRI. Thus, MRI evaluation would be considered a first-line diagnostic tool, but these risk factors could also be used as a supplementary diagnostic tool to suspect ramp lesions in ACL-injured knees irrespective of the direct findings with MRI.…”

What Is the Relationship Between the Distal Semimembranosus Tendon and the Medial Meniscus? A Gross and Microscopic Analysis From the SANTI Study Group

“…23,29,31,37 They are sometimes referred to as “hidden lesions” 31 because, on one hand, their posterior location behind the medial tibiofemoral joint often makes them hard to see on the standard anterior arthroscopic view 31 (hidden by the medial femoral condyle) and, on the other, they are very hard to identify using preoperative magnetic resonance imaging because of the low sensitivity of this modality. 3,7,11,17…”