Meniscal ramp lesions: diagnostic performance of MRI with arthroscopy as reference standard

Abstract

Background The posteromedial meniscal region is gaining interest among orthopedic surgeons, as lesions of this area has been reported to be significantly associated with anterior cruciate ligament tears. The current imaging literature is unclear. Purpose To evaluate the diagnostic performance of MR in the detection of meniscal ramp lesions having arthroscopy as reference standard. Materials and methods We retrospectively included 56 patients (mean age of 25 ± 7 years; 14 females) from January to November 2017 with a arthroscopically proved ACL tear and posterior meniscocapsular separation. On preoperative MRI, two radiologists with 13 and 2 years’ experience in musculoskeletal imaging assessed the presence/absence of ramp lesion, meniscotibial ligament lesion, peripheral meniscal lesion, or their combination, bone bruise. Having arthroscopy as reference standard, diagnostic performance of MRI in the evaluation of ramp area lesions was calculated. Cohen’s kappa (k) and Fisher's Exact Test statistics were used. Results Agreement between radiologists ranged from κ = 0.784 (meniscotibial ligament lesions) to κ = 0.918 red–red meniscal lesion. Sensitivities were 97.4% for ramp lesions, 95.8% for meniscotibial ligament lesion, 94.4% for peripheral meniscal lesions; specificities were 88.9%, 81.3%, and 97.4%, respectively; accuracies were 94.6%, 87.5%, and 96.4%, respectively. Agreement between MR and arthroscopy was almost perfect in identification of ramp lesions (κ = 0.871) and red–red zone meniscal lesions (κ = 0.908). The agreement between the two methods was substantial (κ = 0.751) for meniscotibial lesion. No significant association between tibial plateau bone bruise and the different type of lesions was found (κ ≥ 0.004 and p ≥ 0.08). Conclusion MR has high diagnostic performance in meniscal ramp area lesion assessment, with substantial to almost perfect inter-reader agreement.

High prevalence of meniscal ramp lesions in anterior cruciate ligament injuries

“…Magnetic resonance imaging (MRI) is regarded as the best imaging modality to diagnose meniscal ramp lesions [ 10 , 14 , 43 , 44 ], even though its accuracy has been questioned due to the varying sensitivity reported in previous studies [ 2 , 11 , 19 , 41 ]. In their recent systematic review and meta-analysis, Koo et al [ 21 ] reported that MRI has high specificity (94%) but moderate sensitivity (71%) for diagnosing ramp lesions.…”

Lateral–medial asymmetry of posterior tibial slope and small lateral tibial plateau articular surface depth are morphological factors of lateral meniscus posterior root tears in ACL-injured patients

“…Second, the data were obtained from two different institutions without a unified protocol for diagnosing LMPRT and MM ramp lesions, and assessing whether an ACL was completely or incompletely torn, as they would be influenced by the surgeons' assessment. However, the diagnosis and classification of LMPRT and MM ramp lesions in the literature were still in continuous development and evolution during the study period [16, 43, 46]. Third, MRI scans were not completely controlled for quality (1.5 T and 3.0 T) and the determination of the direction and cranial‐caudal range, which could limit some measurements.…”

Examining Preoperative MRI for Medial Meniscal Ramp Lesions in Patients Surgically Treated for Acute Grade 3 Combined Posterolateral Corner Knee Injury

“…The MRI criteria put forth by Zappia et al 32 were used to define the presence of a ramp lesion in this study. These criteria have exhibited excellent sensitivity, specificity, and interreader reliability for the detection of ramp lesions on MRI relative to arthroscopically confirmed ramps through a posteromedial portal.…”

“…These criteria have exhibited excellent sensitivity, specificity, and interreader reliability for the detection of ramp lesions on MRI relative to arthroscopically confirmed ramps through a posteromedial portal. 32 On MRI, medial meniscal ramp lesions were defined as a vertical (longitudinal) tear of the peripheral capsular attachment of the posterior horn of the medial meniscus at the meniscocapsular junction. Zappia et al’s criteria for diagnosing the presence of a ramp lesion on MRI included if the concave band (ramp capsule) with low signal intensity posterior to the posterior horn of the medial meniscus was interrupted by a line of hyperintensity crossing this capsular reflection.…”