Reliability of MRI diagnosis of RAMP lesions with and without a structured checklist: A study of 200 MRIs

This study intended to evaluate the reliability of diagnosing meniscal RAMP lesions on magnetic resonance imaging (MRI) using a newly developed identification checklist. The primary objective was to standardise MRI interpretation to reduce operator-dependent variability and enhance diagnostic agreement.

In total, 1350 knee MRI scans were initially reviewed, with 200 matching the predefined inclusion and exclusion criteria. Four sports medicine surgeons were divided into two groups: one using the developed RAMP lesion identification checklist and the other interpreting the MRI scans without it. Interobserver reliability was assessed using Cohen's kappa coefficient at two distinct time points. After 1 month, both groups reassessed the MRI scans using the checklist. The Intraclass Correlation Coefficient (ICC) was also calculated to determine the overall diagnostic consistency between the groups.

The introduction of the checklist significantly improved interobserver reliability. In the initial evaluation, the group using the checklist exhibited a higher level of diagnostic agreement (Cohen's kappa = 0.779, 89% agreement) compared to the group without the checklist (Cohen's kappa = 0.057, 60.5% agreement). After 1 month, when both groups used the checklist, diagnostic concordance improved substantially (Cohen's kappa = 0.698, 85% agreement). The ICC between the groups indicated strong diagnostic consistency (0.759), further highlighting the checklist's effectiveness.

The RAMP lesion identification checklist significantly enhances the reliability of MRI-based diagnoses by standardising the interpretation process and reducing observer variability. This protocol offers significant value in the preoperative setting by enhancing diagnostic consensus and surgeon confidence, ultimately allowing for more comprehensive surgical planning. However, further validation studies comparing MRI findings with direct arthroscopic evaluations are necessary to confirm its clinical utility.

Level 3.