Subscribe to RSS
DOI: 10.1055/s-0044-1791791
Meniscal Ramp Injury Diagnosis
Article in several languages: português | English Financial support The authors declare that this research did not receive any grant from financial agencies from the public, commercial, or not-for-profit sources.
Abstract
Objective: This study compared diagnostic methods for meniscal ramp injury (magnetic resonance imaging [MRI], arthrotomography, and arthroscopy) to determine the most sensitive and the agreement level between them.
Method: We studied 21 patients, all young athletes with suspected anterior cruciate ligament (ACL) injury after trauma for at least 3 months and no evidence or history of other osteoarticular injuries in the knee. The patients underwent MRI and arthrotomography. Following ACL injury confirmation, they underwent arthroscopy for ligament reconstruction and evaluation of the medial meniscus to confirm or exclude a ramp injury. McNemar's agreement test compared the diagnostic methods. We also assessed specificity and sensitivity using arthroscopy as the gold standard with a 95% confidence interval and p < 0.005.
Result: The results were consistent with the literature. MRI had 73.3% sensitivity and 83.3% specificity, with 76.2% agreement with the gold standard. Arthrotomography sensitivity and specificity were 100% and 66.7%, respectively, with 90.5% agreement with arthroscopy.
Conclusion: In our study, arthrotomography was the most sensitive diagnostic method and had the highest agreement with the gold standard. We recommend its consideration for diagnosing ACL injuries.
Work carried out at the Department of Orthopedics and Traumatology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
Publication History
Received: 30 May 2022
Accepted: 06 November 2023
Article published online:
07 December 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
Referências
- 1 Sonnery-Cottet B, Serra Cruz R, Vieira TD, Goes RA, Saithna A. Ramp Lesions: An Unrecognized Posteromedial Instability?. Clin Sports Med 2020; 39 (01) 69-81
- 2 Thaunat M, Fayard JM, Guimaraes TM, Jan N, Murphy CG, Sonnery-Cottet B. Classification and Surgical Repair of Ramp Lesions of the Medial Meniscus. Arthrosc Tech 2016; 5 (04) e871-e875
- 3 Hatayama K, Terauchi M, Saito K, Takase R, Higuchi H. Healing Status of Meniscal Ramp Lesion Affects Anterior Knee Stability After ACL Reconstruction. Orthop J Sports Med 2020; 8 (05) 2325967120917674
- 4 DePhillipo NN, Engebretsen L, LaPrade RF. Current Trends Among US Surgeons in the Identification, Treatment, and Time of Repair for Medial Meniscal Ramp Lesions at the Time of ACL Surgery. Orthop J Sports Med 2019; 7 (02) 2325967119827267
- 5 Kumar NS, Spencer T, Cote MP, Arciero RA, Edgar C. Is Edema at the Posterior Medial Tibial Plateau Indicative of a Ramp Lesion? An Examination of 307 Patients With Anterior Cruciate Ligament Reconstruction and Medial Meniscal Tears. Orthop J Sports Med 2018; 6 (06) 2325967118780089
- 6 Alessio-Mazzola M, Lovisolo S, Capello AG. et al. Management of ramp lesions of the knee: a systematic review of the literature. Musculoskelet Surg 2020; 104 (02) 125-133
- 7 Sonnery-Cottet B, Conteduca J, Thaunat M, Gunepin FX, Seil R. Hidden lesions of the posterior horn of the medial meniscus: a systematic arthroscopic exploration of the concealed portion of the knee. Am J Sports Med 2014; 42 (04) 921-926
- 8 Thaunat M, Jan N, Fayard JM. et al. Repair of Meniscal Ramp Lesions Through a Posteromedial Portal During Anterior Cruciate Ligament Reconstruction: Outcome Study With a Minimum 2-Year Follow-up. Arthroscopy 2016; 32 (11) 2269-2277
- 9 Sonnery-Cottet B, Praz C, Rosenstiel N. et al. 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. Am J Sports Med 2018; 46 (13) 3189-3197
- 10 Liu X, Feng H, Zhang H, Hong L, Wang XS, Zhang J. Arthroscopic prevalence of ramp lesion in 868 patients with anterior cruciate ligament injury. Am J Sports Med 2011; 39 (04) 832-837
- 11 Chahla J, Kruckeberg BM, Moatshe G, LaPrade RF. Peripheral Meniscal Tears: How to Diagnose and Repair. In: LaPrade R, Arendt E, Getgood A, Faucett S. eds. The Menisci. Berlin: Springer-Verlag; 2017: 88-83
- 12 Shelbourne KD, Rask BP. The sequelae of salvaged nondegenerative peripheral vertical medial meniscus tears with anterior cruciate ligament reconstruction. Arthroscopy 2001; 17 (03) 270-274
- 13 Arner JW, Herbst E, Burnham JM. et al. MRI can accurately detect meniscal ramp lesions of the knee. Knee Surg Sports Traumatol Arthrosc 2017; 25 (12) 3955-3960
- 14 Greif DN, Baraga MG, Rizzo MG. et al. MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation. Skeletal Radiol 2020; 49 (05) 677-689