Preoperative Moderate Pivot-Shift Phenomenon: A Risk Factor for Ramp Lesions in Patients Undergoing Anterior Cruciate...

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Knee Injuries

Background:

• Ramp lesions are a common intra-articular injury associated with anterior cruciate ligament (ACL) tears.
• Previous studies have identified several risk factors, but their independent impact remains unclear.

Purpose of the Study:

• To quantify the specific impact of preoperative factors on the occurrence of ramp lesions using multivariate and categorical analyses.
• To identify independent predictors for ramp lesions in patients undergoing primary ACL reconstruction.

Main Methods:

• Retrospective review of 262 patients undergoing primary ACL reconstruction (January 2017 - August 2023).
• Exclusion of patients with prior ligamentous injuries or severe concomitant ligament injuries.
• Logistic regression analysis to identify preoperative factors associated with ramp lesions, followed by categorical analysis.

Main Results:

• Ramp lesions were present in 22.1% of patients (58/262).
• Independent predictors for ramp lesions included a higher pivot-shift test grade (OR 1.560), younger age (OR 0.966), and male sex (OR 2.170).
• Categorical analysis showed significantly higher odds of ramp lesions for pivot grade ≥4, age <20 years, and males.

Conclusions:

• A moderate pivot-shift test (grade ≥4) is a significant preoperative risk factor for ramp lesions.
• Younger age (<20 years) and male sex are also independently associated with an increased risk of ramp lesions.
• Preoperative identification of these factors is crucial for reducing the likelihood of overlooking ramp lesions during ACL reconstruction surgery.