Posteromedial geometric parameters associated with ramp lesions in ACL-injured knees
Bahattin Kemah1, Mehmet Akif Cacan2, Emre Koraman3
1Department of Orthopaedics and Traumatology, University of Health Science Umraniye Training and Research Hospital, Istanbul, Turkiye.
Background:
The relationship between posteromedial knee geometry and ramp lesions is not fully defined. This study evaluated whether established radiologic measurements and additional posteromedial geometric parameters are associated with ramp lesion presence in ACL-injured knees.
Methods:
Patients who underwent primary ACL reconstruction were retrospectively reviewed. Adults with preoperative long-leg radiographs, standardized knee MRI, and arthroscopic confirmation of ramp status were included; those with BMI ≥30 kg/m2, prior ipsilateral surgery, revision ACL reconstruction, multiligament injury, periarticular fracture, advanced osteoarthritis or inflammatory arthropathy, meniscal root tear, displaced meniscal tear, or inadequate MRI were excluded. Coronal alignment, lateral tibial slope (LTS), medial tibial slope (MTS), medial meniscal slope (MMS), posterior medial meniscal wedge angle-anterior (PMMWA-A), posterior medial meniscal wedge angle-superior (PMMWA-S), posterior medial meniscal vertical height (PMMVH), and posterior medial meniscal posterior offset-inferior (PMMPO-I) were measured. Group comparisons, point-biserial correlations, multivariable logistic regression, and reliability analyses were performed.
Results:
A total of 203 patients were evaluated and 182 were included (63 ramp-positive, 119 ramp-negative). Pivot-shift grade and medial tibial plateau bone bruise differed between groups. Ramp-positive knees showed greater MMS, PMMWA-A, PMMWA-S, PMMVH, and PMMPO-I, whereas coronal alignment, LTS, and MTS did not differ. PMMPO-I showed the strongest correlation with ramp lesion presence (r = 0.556, p < 0.001). In the combined multivariable model, PMMPO-I and MMS remained independently associated with ramp lesions.
Conclusions:
Ramp lesion presence in ACL-injured knees was associated with selected posteromedial geometric parameters on MRI. After adjustment, PMMPO-I and MMS remained independently associated with ramp lesion presence and may aid MRI-based detection.
