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MRI can accurately detect meniscal ramp lesions of the knee

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Posterior horn meniscal tears are commonly found in conjunction with anterior cruciate ligament (ACL) injury. Some believe tears in the posterior meniscocapsular zone, coined ramp lesions, are important to knee stability. The purpose of this study was to determine whether pre-operative MRI evaluation was able to accurately and reproducibly identify ramp lesions.

Methods

Three blinded reviewers assessed MRIs twice for the presence of ramp lesions in patients undergoing ACL reconstruction. Sensitivity, specificity, negative predictive value, and positive predictive value for MRI were calculated based on arthroscopic diagnosis of a ramp lesion. Intra-class correlation coefficient was calculated to assess intra- and interobserver reliability of the MRI assessment between the three examiners. Significance was set at p < 0.05.

Results

Ninety patients met inclusion criteria (45 males, 45 females, mean age 28.0 years). Thirteen of these patients had arthroscopy-confirmed ramp lesions, while the other 77 had other meniscal pathology. Sensitivity of detecting a ramp lesion on MRI ranged from 53.9 to 84.6%, while specificity was 92.3–98.7%. Negative predictive value was 91.1–97.4%, while positive predictive value was 50.0–90.0%. Inter-rater reliability between three reviewers was moderate at 0.56. The observers had excellent intra-rater reliability ranging from 0.75 to 0.81.

Conclusions

This study demonstrates high sensitivity and excellent specificity in detecting meniscal ramp lesions on MRI. Ramp lesions are likely more common and may have greater clinical implications than previously appreciated; the outcomes of untreated lesions must be investigated. Pre-operative identification of ramp lesions may aid clinicians in surgical planning and patient education to improve outcomes by addressing pathology which may have otherwise been missed.

Level of evidence

III.

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Authors and Affiliations

  1. UPMC Center for Sports Medicine, 3200 S Water St, Pittsburgh, PA, 15203, USA

    Justin W. Arner, Elmar Herbst, Jeremy M. Burnham, Ashish Soni, Jan-Hendrik Naendrup, Adam Popchak, Freddie H. Fu & Volker Musahl

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  1. Justin W. Arner
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  2. Elmar Herbst
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  3. Jeremy M. Burnham
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  4. Ashish Soni
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  6. Adam Popchak
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  7. Freddie H. Fu
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  8. Volker Musahl
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Corresponding author

Correspondence to Volker Musahl.

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All co-authors declare they have no conflict of interest.

Funding

No funding was used for this study.

Ethical approval

This study was performed with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments.

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Arner, J.W., Herbst, E., Burnham, J.M. et al. MRI can accurately detect meniscal ramp lesions of the knee. Knee Surg Sports Traumatol Arthrosc 25, 3955–3960 (2017). https://doi.org/10.1007/s00167-017-4523-9

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  • DOI: https://doi.org/10.1007/s00167-017-4523-9

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