MRI Criteria for Meniscal Ramp Lesions of the Knee in Children With Anterior Cruciate Ligament Tears

Nguyen, Jie C.; Bram, Joshua T.; Lawrence, J. Todd R.; Hong, Shijie; Leska, Tomasina M.; Ganley, Theodore J.; Ho-Fung, Víctor

doi:10.2214/ajr.20.23389

Cited by 17 publications

(11 citation statements)

References 33 publications

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“…The results of this study showed that the knee stability was different when the coronal and sagittal femoral and tibial tunnel angles were different; the knee stability was higher when the coronal and sagittal femoral tunnel angles were between 25°–35° and 20°–30°, respectively; and the knee stability was higher when the coronal and sagittal tibial tunnel angles were between 25°–35° and 60°–70°, respectively. This is in general agreement with the findings of Nguyen et al [ 23 ].…”

Section: Discussionsupporting

confidence: 94%

Three-Dimensional Reconstruction Algorithm-Based Magnetic Resonance Imaging Evaluation of Biomechanical Changes in Articular Cartilage in Patients after Anterior Cruciate Ligament Reconstruction

et al. 2022

Computational Intelligence and Neuroscience

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This study aimed to investigate the evaluation of biomechanical changes in articular cartilage in patients after anterior cruciate ligament (ACL) reconstruction by magnetic resonance imaging (MRI) based on a three-dimensional (3D) finite element model. The data of 90 patients undergoing arthroscopic ACL reconstruction in the hospital were collected and divided into the stable group (54 cases) and the unstable group (36 cases). A load of up to 134N was applied to the 3D finite element model, and the kinematics of knee flexion at 0°, 30°, 60°, and 90° were examined. The tibial anteversion, tibial rotation, and ACL/graft tension were recorded in the 3D finite element model, which was randomly divided into the normal group (intact group, n = 30), the ACL rupture group (deficient group, n = 30), and the anatomical reconstruction group (anatomical group, n = 30). When the graft was fixed at 0°, the anterior tibial translation at 30°, 60°, and 90° in the anatomic group was 8–19% higher than the normal value under 134 N anterior load. The tibial internal rotation in the anatomic group was 18% and 28% higher than the normal value at 30° and 90°. When the graft was fixed at 30°, the anterior tibial translation at 60° and 90° of the anatomic group was 15% higher than the normal value. The tibial internal rotation at 90° of the anatomic group was 16% higher than the normal value, and the above differences had statistical significance P < 0.05 . MRI images were used to assess the bone tunnel angle, and the statistical analysis by the independent-samples t-test showed that there were significant differences in the bone tunnel angle between the stable group and the unstable group P < 0.05 . Currently, based on the 3D finite element model, MRI can accurately evaluate the postoperative effect of anatomical ACL reconstruction in the position, diameter, and angle of tibial and femoral bone tunnels, which can be applied to clinical promotion.

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Section: Discussionsupporting

confidence: 94%

Three-Dimensional Reconstruction Algorithm-Based Magnetic Resonance Imaging Evaluation of Biomechanical Changes in Articular Cartilage in Patients after Anterior Cruciate Ligament Reconstruction

et al. 2022

Computational Intelligence and Neuroscience

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“…Malatray et al 9 found 23% of patients aged 12 to 18 years with posteromeniscal junction rupture. Nguyen et al 10 identified meniscal ramp lesions in 35 of 85 (41%) children with ACL-deficient knees (mean age, 15.3 years; range, 10.2-19.9 years).…”

Section: Discussionmentioning

confidence: 99%

“…Depending on the study, the prevalence of ramp lesions is in the range of 9% to 16%. 2,7 The literature on these lesions in children is very scarce, but the prevalence seems to be higher as described by Liu et al, 7 Malatray et al, 9 and, more recently, Nguyen et al 10…”

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confidence: 93%

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

et al. 2021

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Background: Anterior cruciate ligament (ACL) tears represent 13% of knee injuries in children. Medial meniscal tears are commonly associated with ACL ruptures. Ramp lesions correspond to posterior meniscocapsular tears of the medial meniscus. Depending on the study, the prevalence of ramp lesions is inconsistent. Purpose: To describe the prevalence of ramp lesions in children and adolescents and to investigate the sensitivity of magnetic resonance imaging (MRI) for diagnosing such lesions. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: We analyzed videos from arthroscopic ACL reconstruction (ACLR) in children. During these procedures, we systematically looked for potential ramp lesions. To do so, an arthroscope was passed through the intercondylar notch to visualize the posteromedial compartment. A needle was introduced at the site of a posteromedial portal to unfold the meniscocapsular junction to reveal any hidden meniscal tear. Surgical procedures were performed by 2 senior surgeons. Videos were blindly analyzed by a third surgeon. Preoperative MRIs were screened by 2 blinded, independent senior radiologists to look specifically for ramp lesions. Results: Videos of 50 consecutive arthroscopic ACLRs concerning 32 boys and 18 girls were analyzed. Mean age at surgery was 14.2 years (range, 8.5-17.6 years). A total of 14 ramp lesions (28%) in 8 boys and 6 girls were identified. In addition, there were 22 tears of the meniscal body in 20 patients (40%). Arthroscopic and MRI findings did not correlate. Among 14 arthroscopically diagnosed ramp lesions, only 8 were detected on the MRI. Conversely, 12 patients had a ramp lesion detected on the MRI, which could not be confirmed intraoperatively. The sensitivity of MRI was 57% and the positive predictive value was 40%. Conclusion: A meniscal ramp lesion was present in 14 of 50 children (28%) undergoing ACLR. MRI has a low sensitivity for diagnosis of ramp lesions in children. Careful exploration of the posteromedial compartment is strongly recommended. Overlooking such lesions during ACLR may contribute to ongoing instability and higher re-rupture rates in these young patients.

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“… 29 The most significant findings include peripheral irregularities and hyperintensity (posterior medial tibial plateau oedema) in adults, 30 , 32 whereas MRI scan in children may show medial meniscus and capsular ligament tears in addition to the aforementioned findings (all p < 0.05). 33 Moreover, in order to increase diagnostic accuracy, a knee should be placed in flexed position whenever feasible. 16 Incidence of MRL increases with the duration of ACL injury.…”

Section: Pre-operative Evaluationmentioning

confidence: 99%

Ramp lesion of the medial meniscus

et al. 2021

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Ramp lesion of the medial meniscus used to be completely disregarded in the past. Ramp lesion has been now put under the spotlight by orthopaedic and sport medicine surgeons and requires attention. It is closely associated with anterior cruciate ligament injury. Major risk factors include chronic laxity, lateral meniscal lesion, anterior cruciate ligament reconstruction revision, anterolateral ligament tear concomitant with anterior cruciate ligament injury, time from injury, pre-operative side-to-side laxity > 6 mm, age < 30 years old, male sex, etc. Radiologists attempt to create diagnostic criteria for ramp lesion using magnetic resonance imaging. However, the only definite method to diagnose ramp lesion is still arthroscopy. Various techniques exist, among which posteromedial approach is the most highly recommended. Various treatment options are available. The success rate of ramp repair is very high. Major complications are uncommon. Cite this article: EFORT Open Rev 2021;6:372-379. DOI: 10.1302/2058-5241.6.200126

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MRI Criteria for Meniscal Ramp Lesions of the Knee in Children With Anterior Cruciate Ligament Tears

Cited by 17 publications

References 33 publications

Three-Dimensional Reconstruction Algorithm-Based Magnetic Resonance Imaging Evaluation of Biomechanical Changes in Articular Cartilage in Patients after Anterior Cruciate Ligament Reconstruction

Three-Dimensional Reconstruction Algorithm-Based Magnetic Resonance Imaging Evaluation of Biomechanical Changes in Articular Cartilage in Patients after Anterior Cruciate Ligament Reconstruction

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

Ramp lesion of the medial meniscus

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