Meniscal Ramp Lesions in Adolescent Patients Undergoing Primary Anterior Cruciate Ligament Reconstruction: Response

Abstract

We are writing in regard to the recently published study by Hollnagel et al. 1 The authors propose that a cartilage striation on the femoral condyle correlates with a ramp lesion of the posterior horn of the medial meniscus in adolescent anterior cruciate ligament (ACL)-deficient knees. They recommend using this as a sign to aid arthroscopic identification. We are in complete agreement with this recommendation. However, in terms of the citations, they make no reference to a strikingly similar study from 2022 by Murgier et al 3 in which an identical sign is described, but named differently, as the ''crevice sign.'' The latter study confirmed the hypothesis that there would be a strong correlation between the presence of an unstable medial meniscal tear and the crevice sign in patients with ACL-deficient knees. Furthermore, this was demonstrated with high specificity and positive predictive value. On the one hand, it is reassuring to see that others have identified the importance of the crevice sign, 4 further expanding the demographic diversity of findings with this recent series from an adolescent population. However, the lack of a valid literature search on the subject may explain the absence of appropriate referencing to a sign that has already been identified and named in the literature. Of further relevance is that both our original study and this more recent one highlight the growing emphasis on medial meniscal repair in ACL-reconstructed knees because of the subsequent improvements in stability conferred. When considering the possible pathogenesis involved, Inoue et al 2 reported that at 90°of flexion, in ACL-deficient knees, the posterior portion of the medial meniscus is deformed because of compression against the medial femoral posterior condyle. This is the point at which the crevice sign can be detected. Given the risk of osteoarthritis that arises from meniscal tears associated with ACL injuries, 5 meniscal repair has a clear role in the ACL-reconstructed knee. 6 The crevice sign facilitates the diagnosis of this in a variety of age groups.

Effectiveness of a rehabilitation protocol after anterior cruciate ligament reconstruction in returning to match rhythm: a case study of a professional soccer player

“…These systems offer high precision in measuring knee joint displacements, contributing to more accurate and timely diagnoses of ACL injuries, which are crucial for preventing joint instability and irreversible damage (Kokkotis et al, 2022). Furthermore, leveraging explainable machine learning and gait biomechanical parameters has shown promise in identifying factors associated with ACL injuries, emphasizing the role of technology in improving diagnostic capabilities in this field (Edmonds, 2023).…”