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MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation

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Abstract

Background

Meniscal ramp lesions have been defined as longitudinal vertical peripheral tears of the medial meniscus involving the posterior meniscocapsular ligament, meniscotibial ligament, and/or the red-red zone of the posterior horn. They are heavily associated with anterior cruciate ligament injuries, and because of their potentially important biomechanical role in knee stabilization, injuries to this region may require surgical repair. However, due to their location and lack of general knowledge regarding their different types and associated appearances on magnetic resonance imaging, ramp lesions are routinely underreported. This is compounded by the fact that ramp lesions are also often overlooked during conventional anterior portal arthroscopy when direct visualization is not achieved.

Purpose

To demonstrate MRI appearances and arthroscopic findings of the different types of meniscal ramp lesions, in the hopes of improving their detection on pre-operative imaging.

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References

  1. Bisson LJ, et al. A prospective study of the association between bone contusion and intra-articular injuries associated with acute anterior cruciate ligament tear. Am J Sports Med. 2013;41(8):1801–7.

    Article  PubMed  Google Scholar 

  2. Hagino T, et al. Meniscal tears associated with anterior cruciate ligament injury. Arch Orthop Trauma Surg. 2015;135(12):1701–6.

    Article  PubMed  Google Scholar 

  3. Strobel MJ. Manual of arthroscopic surgery. New York, NY: Springer; 1988.

    Google Scholar 

  4. Chahla J, et al. Meniscal ramp lesions: anatomy, incidence, diagnosis, and treatment. Orthop J Sports Med. 2016;4(7):2325967116657815.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Bumberger A, et al. Ramp lesions are frequently missed in ACL-deficient knees and should be repaired in case of instability. Knee Surg Sports Traumatol Arthrosc. 2019.

  6. Balazs GC, et al. Ramp lesions of the medial meniscus in patients undergoing primary and revision ACL reconstruction: prevalence and risk factors. Orthop J Sports Med. 2019;7(5):2325967119843509.

    Article  PubMed Central  PubMed  Google Scholar 

  7. DePhillipo NN, et al. Quantitative and qualitative assessment of the posterior medial meniscus anatomy: defining meniscal ramp lesions. Am J Sports Med. 2019;47(2):372–8.

    Article  PubMed  Google Scholar 

  8. Ahn JH, Wang JH, Yoo JC. Arthroscopic all-inside suture repair of medial meniscus lesion in anterior cruciate ligament--deficient knees: results of second-look arthroscopies in 39 cases. Arthroscopy. 2004;20(9):936–45.

    Article  PubMed  Google Scholar 

  9. Liu X, et al. Is it necessary to repair stable ramp lesions of the medial meniscus during anterior cruciate ligament reconstruction? A prospective randomized controlled trial. Am J Sports Med. 2017;45(5):1004–11.

    Article  PubMed  Google Scholar 

  10. Hetsroni I, Lillemoe K, Marx RG. Small medial meniscocapsular separations: a potential cause of chronic medial-side knee pain. Arthroscopy. 2011;27(11):1536–42.

    Article  PubMed  Google Scholar 

  11. DePhillipo NN, et al. Incidence and detection of meniscal ramp lesions on magnetic resonance imaging in patients with anterior cruciate ligament reconstruction. Am J Sports Med. 2017;45(10):2233–7.

    Article  PubMed  Google Scholar 

  12. Sonnery-Cottet B, et al. 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(4):921–6.

    Article  PubMed  Google Scholar 

  13. Young, R., B.M. Devitt, and T. Whitehead, Meniscal ramp lesions: diagnosis and treatment strategies, in The menisci: a comprehensive review of their anatomy, biomechanical function and surgical treatment, R.F. LaPrade, et al., Editors. 2017, Springer Berlin Heidelberg: Berlin, Heidelberg p 63-75.

  14. Seil R, et al. Ramp lesions : tips and tricks in diagnostics and therapy. Orthopade. 2017;46(10):846–54.

    Article  CAS  PubMed  Google Scholar 

  15. Mouton, C., et al., Ramp lesions of the medial meniscus are associated with a higher grade of dynamic rotatory laxity in ACL-injured patients in comparison to patients with an isolated injury. Knee Surg Sports Traumatol Arthrosc, 2019.

  16. Vaquero-Picado A, Rodriguez-Merchan EC. Arthroscopic repair of the meniscus: surgical management and clinical outcomes. EFORT Open Rev. 2018;3(11):584–94.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Strobel MJ. Manual of arthroscopic surgery. Berlin: Springer; 2013.

    Google Scholar 

  18. Johannsen AM, et al. Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med. 2012;40(10):2342–7.

    Article  PubMed  Google Scholar 

  19. Rath E, Richmond JC. The menisci: basic science and advances in treatment. Br J Sports Med. 2000;34(4):252–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Vedi V, et al. Meniscal movement. An in-vivo study using dynamic MRI. J Bone Joint Surg Br. 1999;81(1):37–41.

    Article  CAS  PubMed  Google Scholar 

  21. Kaplan PA, et al. Bone contusions of the posterior lip of the medial tibial plateau (contrecoup injury) and associated internal derangements of the knee at MR imaging. Radiology. 1999;211(3):747–53.

    Article  CAS  PubMed  Google Scholar 

  22. Song GY, et al. Increased medial meniscal slope is associated with greater risk of ramp lesion in noncontact anterior cruciate ligament injury. Am J Sports Med. 2016;44(8):2039–46.

    Article  PubMed  Google Scholar 

  23. Papageorgiou CD, et al. The biomechanical interdependence between the anterior cruciate ligament replacement graft and the medial meniscus. Am J Sports Med. 2001;29(2):226–31.

    Article  CAS  PubMed  Google Scholar 

  24. Stephen JM, et al. Posteromedial Meniscocapsular lesions increase tibiofemoral joint laxity with anterior cruciate ligament deficiency, and their repair reduces laxity. Am J Sports Med. 2016;44(2):400–8.

    Article  PubMed  Google Scholar 

  25. Shelbourne KD, Rask BP. The sequelae of salvaged nondegenerative peripheral vertical medial meniscus tears with anterior cruciate ligament reconstruction. Arthroscopy. 2001;17(3):270–4.

    Article  PubMed  Google Scholar 

  26. Liu X, et al. Arthroscopic prevalence of ramp lesion in 868 patients with anterior cruciate ligament injury. Am J Sports Med. 2011;39(4):832–7.

    Article  PubMed  Google Scholar 

  27. Duchman KR, et al. The fate of meniscus tears left in situ at the time of anterior cruciate ligament reconstruction: a 6-year follow-up study from the MOON cohort. Am J Sports Med. 2015;43(11):2688–95.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Thaunat M, et al. Classification and surgical repair of ramp lesions of the medial meniscus. Arthrosc Tech. 2016;5(4):e871–5.

    Article  PubMed Central  PubMed  Google Scholar 

  29. DePhillipo NN, et al. Effect of meniscocapsular and meniscotibial lesions in ACL-deficient and ACL-reconstructed knees: a biomechanical study. Am J Sports Med. 2018;46(10):2422–31.

    Article  PubMed  Google Scholar 

  30. Naendrup JH, et al. Effect of meniscal ramp lesion repair on knee kinematics, bony contact forces, and in situ forces in the anterior cruciate ligament. Am J Sports Med. 2019;47(13):3195–202.

    Article  PubMed  Google Scholar 

  31. Song GY, et al. Risk factors associated with grade 3 pivot shift after acute anterior cruciate ligament injuries. Am J Sports Med. 2016;44(2):362–9.

    Article  PubMed  Google Scholar 

  32. Peltier A, et al. The role of the meniscotibial ligament in posteromedial rotational knee stability. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):2967–73.

    Article  CAS  PubMed  Google Scholar 

  33. Noyes FR, et al. Greater than 10-year results of red-white longitudinal meniscal repairs in patients 20 years of age or younger. Am J Sports Med. 2011;39(5):1008–17.

    Article  PubMed  Google Scholar 

  34. Sonnery-Cottet B, 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):3189–97.

    Article  PubMed  Google Scholar 

  35. Hash TW 2nd. Magnetic resonance imaging of the knee. Sports Health. 2013;5(1):78–107.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Magee T, Williams D. 3.0-T MRI of meniscal tears. AJR Am J Roentgenol. 2006;187(2):371–5.

    Article  PubMed  Google Scholar 

  37. Koo B, et al. Diagnostic performance of magnetic resonance imaging for detecting meniscal ramp lesions in patients with anterior cruciate ligament tears: a systematic review and meta-analysis. The American Journal of Sports Medicine. 0(0):0363546519880528.

  38. Vande Berg BC, et al. Anterior cruciate ligament tears and associated meniscal lesions: assessment at dual-detector spiral CT arthrography. Radiology. 2002;223(2):403–9.

    Article  PubMed  Google Scholar 

  39. Vande Berg BC, et al. Dual-detector spiral CT arthrography of the knee: accuracy for detection of meniscal abnormalities and unstable meniscal tears. Radiology. 2000;216(3):851–7.

    Article  CAS  PubMed  Google Scholar 

  40. De Smet AA, Graf BK. Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears. AJR Am J Roentgenol. 1994;162(4):905–11.

    Article  PubMed  Google Scholar 

  41. Bollen SR. Posteromedial meniscocapsular injury associated with rupture of the anterior cruciate ligament: a previously unrecognised association. J Bone Joint Surg Br. 2010;92(2):222–3.

    Article  CAS  PubMed  Google Scholar 

  42. Yeo Y, et al. MR evaluation of the meniscal ramp lesion in patients with anterior cruciate ligament tear. Skelet Radiol. 2018;47(12):1683–9.

    Article  Google Scholar 

  43. De Maeseneer M, et al. Normal and abnormal medial meniscocapsular structures: MR imaging and sonography in cadavers. AJR Am J Roentgenol. 1998;171(4):969–76.

    Article  PubMed  Google Scholar 

  44. Kumar NS, et al. Anatomic repair of posteromedial meniscocapsular separation using an all-inside technique. Arthrosc Tech. 2017;6(4):e921–6.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Buyukdogan K, Laidlaw MS, Miller MD. Meniscal ramp lesion repair by a trans-septal portal technique. Arthrosc Tech. 2017;6(4):e1379–86.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Thaunat M, et al. Arthroscopic all-inside repair of medial meniscus grade 2 horizontal cleavage tear using additional posteromedial portal. Arthrosc Tech. 2018;7(9):e939–43.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Black AK, et al. Technique for arthroscopically assisted superficial and deep medial collateral ligament-meniscotibial ligament repair with internal brace augmentation. Arthrosc Tech. 2018;7(11):e1215–9.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Beaufils P, et al. The knee meniscus: management of traumatic tears and degenerative lesions. EFORT Open Rev. 2017;2(5):195–203.

    Article  PubMed Central  PubMed  Google Scholar 

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Correspondence to Dylan N. Greif.

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Greif, D.N., Baraga, M.G., Rizzo, M.G. et al. MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation. Skeletal Radiol 49, 677–689 (2020). https://doi.org/10.1007/s00256-020-03381-4

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  • DOI: https://doi.org/10.1007/s00256-020-03381-4

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