Ramp lesions: a systematic review of MRI diagnostic accuracy and treatment efficacy

Abstract

Purpose We conducted a systematic review of the published literature to assess the accuracy of Magnetic Resonance Imaging (MRI) in establishing the presence of ramp lesions (RLs) in Anterior Cruciate Ligament (ACL) deficient knees and the clinical efficacy of the surgical repair of RLs. Methods A comprehensive search of the MEDLINE, Web of Science and Scopus databases was performed according to PRISMA guidelines. Studies assessing MRI diagnostic accuracy for RLs or the clinical effect of RL repair in participants with ACL injuries were included. Diagnostic accuracy measures were pooled and plotted in forest plots. Preoperative and at last follow-up treatment efficacy outcome measures were extracted and plotted in forest plots, for graphical comprehension. Results Sixteen studies met the criteria and were included. The diagnostic analysis showed a pooled sensitivity, specificity, positive and negative likelihood ratios of 65.1% (95% CI, 59.73 to 70.42), 91.6% (95% CI, 89.14 to 94.05), 2.91 (95% CI, 2.38–3.55) and 0.53 (95% CI, 0.44–0.64), respectively, with high heterogeneity (I2 above 80%) for all measures. Treatment analysis showed improved Lysholm Knee Score, IKDC score and laxity difference between the knees in all studies after meniscal suture repair. A separate analysis showed no differences between repair of smaller, stable, RLs with meniscal sutures and repair with abrasion and trephination only. Conclusion Although the results present considerable heterogeneity, MRI seems to demonstrate moderate accuracy in the diagnosis of RLs in patients with ACL tear and the surgical repair of RLs can be associated with improved overall outcomes.

Ramp lesions are six times more likely to be observed in the presence of a posterior medial tibial bone bruise in ACL-injured patients

“…The preoperative diagnosis of ramp lesions is difficult. There are currently no effective clinical tests or signs allowing to detect these lesions and magnetic resonance imaging (MRI) has been reported to have a poor sensitivity [26]. A systematic review of MRI diagnostic accuracy reported a pooled sensitivity of 65.1% (95% CI 59.7 to 70.4%) based on 9 studies [26].…”

Identifying Clinical and MRI Characteristics Associated with Quality of Life in Patients with Anterior Cruciate Ligament Injury: Prognostic Factors for Long-Term

“…Functional outcome score (The International Knee Documentation Committee (IKDC) score) was obtained and considered the main clinical outcome variable. The IKDC evaluation form is a validated instrument to record the clinical state of ACL reconstructed patients at one time [ 27 , 28 ]. The IKDC scores form was used to measure QOL in our statistical analysis.…”

Meniscal ramp lesions: an illustrated review

“…Acute ACL tear is associated with meniscal injuries in more than 50% of subjects, and in more than 80% of chronic ACL tear cases. Medial meniscus is firmly attached to the tibia and femur, acting as a knee stabilizer, and preventing anterior translation, especially in the ACL-deficient knee, thus being especially susceptible to injuries [3].…”