Magnetic Resonance Imaging Diagnosis of Medial Meniscal Ramp Lesions in Patients With Anterior Cruciate Ligament Injuries

Hatayama, Kazumi; Terauchi, Masanori; Saitô, Kenichi; Aoki, Jun; Nonaka, Satoshi; Handa, Hiroshi

doi:10.1016/j.arthro.2017.12.022

Cited by 68 publications

(92 citation statements)

References 19 publications

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“…However, most acute knee MRI evaluations are performed with the knee in full extension, which reduces the meniscocapsular gap, and can lead to false-negative tests. 29 The MRI detected presence of bone bruising in the postero-medial tibial plateau has also been associated with ramp lesions, at a rate that varies from 38.5% for Hatayama and colleagues, 28 66.3% for Kumar and colleagues, 30 and 72.0% for DePhillipo and colleagues. 27 Arthroscopy is considered gold standard for diagnosis of ramp lesions.…”

Section: Objective Diagnosismentioning

confidence: 96%

“…12 Recently, a broad range of sensitivities of both 1.5T 25,27,28 and 3T 27,28 MRI for the detection of ramp lesions has been reported by DePhillipo and colleagues 27 (48%), Hatayama and colleagues 28 (71.7%), and Arner and colleagues 25 (53.9%-84.6%), with a high specificity (>90%). 25,28 The most specific sign in the MRI evaluation of ramp lesions is the hyperintense signal that can be observed between the meniscus and the capsule 29 (Fig. 2).…”

Section: Objective Diagnosismentioning

confidence: 99%

“…6 However, it is not without pitfalls. 28 Forty percent of ramp lesions are not identified through standard anterior portal visualization and inspection of the posterior compartment via a trans-notch view, and posteromedial probing is required to identify them. 6,7 This is of particular importance, because these missed tears are repairable.…”

Section: Objective Diagnosismentioning

confidence: 99%

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Ramp Lesions

Sonnery‐Cottet

Cruz

Vieira

et al. 2020

Clinics in Sports Medicine

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Section: Objective Diagnosismentioning

confidence: 96%

Section: Objective Diagnosismentioning

confidence: 99%

Section: Objective Diagnosismentioning

confidence: 99%

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Ramp Lesions

Sonnery‐Cottet

Cruz

Vieira

et al. 2020

Clinics in Sports Medicine

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“…50 Imaging is also unreliable and a number of studies have reported difficulty identifying these lesions with MRI, which has a high specificity, but a moderate sensitivity, leading to an underestimation the true incidence. 3,6,10,15,20,37 For example, Bollen et al reported that preoperative MRI failed to detect a single ramp lesion in a group of eleven knees with arthroscopically confirmed lesions. 6 In the current study, a systematic evaluation of the posteromedial compartment was undertaken in all 3214 knees.…”

Section: Risk Factors For Ramp Lesionsmentioning

confidence: 99%

“…1,43 It is therefore considered important to identify these lesions in order to repair them when necessary. However, it should be noted that historically these injuries were probably under-appreciated because pre-operative examination 50 and imaging modalities 3,6,15,20,37 have a low sensitivity for ramp lesions. Furthermore, a substantial number of these lesions may also be missed at the time of arthroscopic evaluation, particularly if this is performed using standard anterior portal viewing only.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological Evaluation of Meniscal Ramp Lesions in 3214 Anterior Cruciate Ligament–Injured Knees From the SANTI Study Group Database: A Risk Factor Analysis and Study of Secondary Meniscectomy Rates Following 769 Ramp Repairs

et al. 2018

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Background: Ramp lesions are characterized by disruption of the peripheral meniscocapsular attachments of the posterior horn of the medial meniscus. Ramp repair performed at the time of ACL reconstruction has been shown to improve knee biomechanics. Hypothesis/Purpose: Primary objectives of this study were to evaluate the incidence and risk factors for ramp lesions in a large series of patients undergoing ACL reconstruction, Secondary objectives were to determine the re-operation rate for failure of ramp repair, defined by subsequent re-operations for partial medial meniscectomy Study Design: Case series Methods: All patients underwent trans-notch posteromedial compartment evaluation of the knee during ACL reconstruction. Ramp repair was performed if a lesion was detected. Potentially important risk factors were analyzed for their association with ramp lesions. A secondary analysis of all patients who underwent ramp repair and had a minimum follow-up of two years was undertaken in order to determine the secondary partial meniscectomy rate for failed ramp repair. Results: The overall incidence of ramp lesions in the study population was 23.9% (769 ramp lesions in 3214 patients). Multivariate analysis demonstrated that the presence of ramp lesions was significantly associated with the following risk factors: male gender, patients aged under 30 years, revision ACLR, chronic injuries, pre-operative side-to-side laxity >6 mm and the presence of concomitant lateral meniscus tears. The secondary meniscectomy rate was 10.8% at a mean follow up of 45.6 months (24.2-66.2). Patients who underwent ACLR + ALLR had a greater than 2-fold reduction in the risk of reoperation for failure of ramp repair as compared with patients who underwent isolated ACLR (hazard ratio, 0.457; 95%CI, 0.226-0.864; P = .021) 3 Conclusion: There is a high incidence of ramp lesions in patients undergoing ACLR. The identification of important risk factors for ramp lesions in this study in an individual patient should help raise an appropriate index of suspicion and prompt posteromedial compartment evaluation. The overall secondary partial meniscectomy rate after ramp repair is 10.8%. Anterolateral ligament reconstruction appears to confer a protective effect on the ramp repair performed at the time of ACLR and results in a significant reduction in secondary meniscectomy rates.

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Meniscal ramp lesion classification systems: A systematic review

Allende,

Berreta,

Allahabadi

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo describe the proposed classification systems for meniscal ramp lesions (RLs) in the literature and evaluate their accuracy and reliability.MethodsA systematic search was conducted according to the Preferred Reporting Items for Systematic reviews and Meta‐analyses guidelines utilising PubMed, Embase and Cochrane Library databases. Level I–IV studies referencing RLs along with either an arthroscopic‐ or magnetic resonance imaging (MRI)‐based classification system used to describe RL subtypes were included.ResultsIn total, 21 clinical studies were included. Twenty‐seven (79%) of the included studies were published in 2020 or later. There were four main classification systems proposed within the literature (two arthroscopic‐, two MRI‐based), describing tear patterns, mediolateral extent, associated ligament disruption and stability of the lesion. The first classification was proposed in 2015 by Thaunat et al. and is referenced in 22 (64.7%) of the included studies. The application of the Thaunat et al. criteria to MRI showed variable sensitivity (31.70%–93.8%) and interobserver agreement (k = 0.55–0.80). The Greif et al. modification to the Thaunat et al. system was referenced in 32.4% of the included studies and had a substantial interobserver agreement (k = 0.8). Stability to probing and specific tear location were each used to classify RLs in 28.6% and 23.8% of the included clinical studies, respectively.ConclusionAlthough there has been a recent increase in the recognition and treatment of meniscal RLs, there is limited consistency in descriptive classifications used for this pathology. Current RL classification systems based on preoperative MRI have variable reliability, and arthroscopic examination remains the gold standard for diagnosis and classification.Level of EvidenceLevel IV.

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Magnetic Resonance Imaging Diagnosis of Medial Meniscal Ramp Lesions in Patients With Anterior Cruciate Ligament Injuries

Cited by 68 publications

References 19 publications

Ramp Lesions

Ramp Lesions

Epidemiological Evaluation of Meniscal Ramp Lesions in 3214 Anterior Cruciate Ligament–Injured Knees From the SANTI Study Group Database: A Risk Factor Analysis and Study of Secondary Meniscectomy Rates Following 769 Ramp Repairs

Meniscal ramp lesion classification systems: A systematic review

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