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How to Detect Meniscal Ramp Lesions Using Ultrasound.

ABSTRACT: The clinical importance of meniscal ramp lesions in patients with anterior cruciate ligament tears has emerged. However, the diagnostic accuracy of magnetic resonance imaging for detecting meniscal ramp lesions is low. The advantage of ultrasonography is that it can be performed in any position and is a real-time imaging modality. The goal of this Technical Note is to describe in detail the ultrasound technique that we use to detect meniscal ramp lesions in patients with anterior cruciate ligament tears. The semimembranosus muscle is a reliable landmark for this technique. The examination position is prone, with the knee joint flexed to 70°. The most important part of this technique is to instruct the patient to perform isometric contractions in knee flexion with the support of an assistant. The presence or absence of a meniscal ramp lesion can be diagnosed preoperatively by setting the probe above the semimembranosus tendon.

SUBMITTER: Nakase J

PROVIDER: S-EPMC8252820 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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How to Detect Meniscal Ramp Lesions Using Ultrasound.

Nakase Junsuke J Asai Kazuki K Yoshimizu Rikuto R Kimura Mitsuhiro M Tsuchiya Hiroyuki H

Arthroscopy techniques 20210517 6

The clinical importance of meniscal ramp lesions in patients with anterior cruciate ligament tears has emerged. However, the diagnostic accuracy of magnetic resonance imaging for detecting meniscal ramp lesions is low. The advantage of ultrasonography is that it can be performed in any position and is a real-time imaging modality. The goal of this Technical Note is to describe in detail the ultrasound technique that we use to detect meniscal ramp lesions in patients with anterior cruciate ligame ...[more]

PMID: 34258202

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Project description:PurposeTo establish the magnetic resonance imaging (MRI) and operative incidence of ramp lesions in a consecutive group of patients who had undergone anterior cruciate ligament reconstruction (ACLR) and to propose a graded radiologic classification that seeks to define key preoperative features that most strongly correlate with arthroscopically confirmed ramp lesions.MethodsAfter retrospective review, all consecutive patients who underwent ACLR with preoperative MRI over a 16-month period were included in the study. Diagnostic arthroscopy with direct visualization of the posteromedial compartment was used to establish the true incidence of ramp lesions. Three radiologists, blinded to the surgical findings, independently analyzed the MRI scans of all patients and classified the signal intensity at the posterior meniscocapsular junction using 4 criteria (type 1, diffuse increased signal equal to adjacent femoral cartilage; type 2, diffuse increased signal greater than cartilage; type 3, diffuse increased signal plus full-height linear fluid-signal cleft; and type 4, full-height fluid-signal meniscocapsular separation). Interobserver reliability, in addition to sensitivity, specificity, and positive and negative predictive values, was calculated.ResultsOf the 93 patients included (mean age, 26.7 years), 11 (11.8%) were confirmed to have ramp lesions on arthroscopy. Inter-rater reliability for the MRI diagnosis of the positive ramp lesions was good, at 0.75. Type 3 criteria were the most accurate, producing average sensitivity and specificity values of 85% and 82%, respectively.ConclusionsRamp lesions are not infrequently encountered in ACLR and, if not recognized at the time of surgery, may contribute to inferior outcomes. MRI is an effective method of preoperative assessment, and the presence of type 3 changes should be used as criteria for radiologically definitive ramp lesion diagnosis.Clinical relevanceThis study highlights the incidence of meniscal ramp lesions encountered in ACLR surgery and the effectiveness of MRI as a preoperative imaging modality.

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How to Detect Meniscal Ramp Lesions Using Ultrasound.

Publications

How to Detect Meniscal Ramp Lesions Using Ultrasound.

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