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Meniscal ramp lesions: diagnostic performance of MRI with arthroscopy as reference standard
Marcello Zappia1,2, Luca Maria Sconfienza3,4, Salvatore Guarino5
1Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.
Background:
The posteromedial meniscal region is gaining interest among orthopedic surgeons, as lesions of this area has been reported to be significantly associated with anterior cruciate ligament tears. The current imaging literature is unclear.
Purpose:
To evaluate the diagnostic performance of MR in the detection of meniscal ramp lesions having arthroscopy as reference standard.
Materials And Methods:
We retrospectively included 56 patients (mean age of 25 ± 7 years; 14 females) from January to November 2017 with a arthroscopically proved ACL tear and posterior meniscocapsular separation. On preoperative MRI, two radiologists with 13 and 2 years' experience in musculoskeletal imaging assessed the presence/absence of ramp lesion, meniscotibial ligament lesion, peripheral meniscal lesion, or their combination, bone bruise. Having arthroscopy as reference standard, diagnostic performance of MRI in the evaluation of ramp area lesions was calculated. Cohen's kappa (k) and Fisher's Exact Test statistics were used.
Results:
Agreement between radiologists ranged from κ = 0.784 (meniscotibial ligament lesions) to κ = 0.918 red-red meniscal lesion. Sensitivities were 97.4% for ramp lesions, 95.8% for meniscotibial ligament lesion, 94.4% for peripheral meniscal lesions; specificities were 88.9%, 81.3%, and 97.4%, respectively; accuracies were 94.6%, 87.5%, and 96.4%, respectively. Agreement between MR and arthroscopy was almost perfect in identification of ramp lesions (κ = 0.871) and red-red zone meniscal lesions (κ = 0.908). The agreement between the two methods was substantial (κ = 0.751) for meniscotibial lesion. No significant association between tibial plateau bone bruise and the different type of lesions was found (κ ≥ 0.004 and p ≥ 0.08).
Conclusion:
MR has high diagnostic performance in meniscal ramp area lesion assessment, with substantial to almost perfect inter-reader agreement.
Insights
Magnetic resonance imaging (MRI) demonstrates high accuracy in detecting meniscal ramp lesions, offering substantial to almost perfect inter-reader agreement for orthopedic surgeons. This imaging technique aids in diagnosing these specific knee injuries effectively.
Area of Science:
- Orthopedic Surgery
- Radiology
- Sports Medicine
Background:
- The posteromedial meniscal region is increasingly recognized for its association with anterior cruciate ligament (ACL) tears.
- Existing imaging literature on meniscal ramp lesions remains inconclusive.
- Accurate diagnosis of ramp lesions is crucial for effective knee injury management.
Purpose of the Study:
- To evaluate the diagnostic performance of Magnetic Resonance (MR) imaging in detecting meniscal ramp lesions.
- To establish arthroscopy as the reference standard for diagnosis.
- To clarify the utility of MR in identifying associated meniscal and bone injuries.
Main Methods:
- Retrospective analysis of 56 patients with arthroscopically confirmed ACL tears and posterior meniscocapsular separation.
- Preoperative MR imaging assessed for ramp lesions, meniscotibial ligament lesions, peripheral meniscal lesions, and bone bruises.
- Two musculoskeletal radiologists with varying experience evaluated MR images; arthroscopy served as the gold standard.
Main Results:
- MR imaging demonstrated high sensitivity (97.4%) and specificity (88.9%) for ramp lesions.
- Inter-reader agreement for ramp lesions between MR and arthroscopy was almost perfect (κ=0.871).
- Substantial agreement (κ=0.751) was found for meniscotibial lesions; no significant association between bone bruise and lesions was identified.
Conclusions:
- MR imaging exhibits high diagnostic performance for assessing meniscal ramp area lesions.
- The study confirms substantial to almost perfect inter-reader agreement for MR interpretation of these lesions.
- MR imaging is a reliable tool for diagnosing meniscal ramp lesions in patients with ACL tears.
