By Alper Kaya 4 Videos. MR evaluation of the meniscal ramp lesion in patients with anterior cruciate ligament tear 24 June 2018 | Skeletal Radiology, Vol. Type 2 : Partial superior lesions. RAMP Lesion Identification and Repair. -, Radiology. Concomitant injuries on the structures of the posteromedial and posterolateral corners of the knee, including PHMM tear and meniscal ramp lesion, were recorded. Bivariate and hierarchical summary receiver operating characteristic modeling was used to evaluate the diagnostic performance. The bone bruise involves the posterolateral tibial plateau and mid part of the lateral femoral condyle. Privacy, Help eCollection 2021 Apr. They are strongly associated with acute and chronic anterior cruciate ligament (ACL) tears. Unstable ramp lesions were present in 73 (20%) patients, and stable ramp lesions were present in 82 (22%) patients. Seven ramp lesions were noted on arthroscopy (9%). Radiology department of the Onze Lieve Vrouwe Gasthuis, Amsterdam and the Rijnland hospital, Leiderdorp, the Netherlands Publicationdate 2013-11-01 In the article Bone Tumors - Differential diagnosis we discussed a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. RAMP lesion of knee is menisco-capsular separation of medial meniscus and needs to be repaired to provide better rotational stability to knee This is compounded by the fact that ramp lesions are also often overlooked during conventional anterior portal arthroscopy when direct visualization is not achieved. Since they can go unnoticed in the arthroscopic evaluation, radiologists have an important role in the … March 8, 2018. The objective of this article is to review the recent literature regarding meniscal ramp lesions and to summarize the anatomical, biomechanical and fundamentally diagnostic aspects, emphasizing the radiological findings described until now. Therefore, to rule out a ramp lesion, an arthroscopic evaluation with probing of the posterior horn … Routine arthroscopic assessment is recommended for the presence of ramp lesion, regardless of whether it is suspected on MRI. Since this type of injury is often underdiagnosed due to its localization at the “blind” point of arthroscopic vision, it is crucial to make an accurate preoperative diagnosis of them with MRI. 38 Regardless of the … Results: Seven ramp lesions were noted on arthroscopy (9%). Findings of irregularity at the posterior margin (p = 0.001) and complete fluid filling between the posterior horn of the medial meniscus and the capsule margin (p = 0.004) on magnetic resonance imaging were significantly associated with the presence of a ramp lesion. Failure to recognize and treat meniscal tears at the time of ACL reconstruction can have long-term consequences, incl… ObjectiveTo identify the findings on magnetic resonance imaging most strongly associated with meniscal ramp lesions in patients with an anterior cruciate ligament tear.Subjects and methodsSeventy-eight consecutive patients (mean age, 33.7 years; 64 male, 14 female) with an arthroscopically proven anterior cruciate ligament tear were included in this retrospective study. Although knee Stener-like lesions have been previously described in the orthopedic literature [11–13, 16, 17], we are unaware of any reports in the radiology literature. • Whether any longitudinal tear (ramp lesion) • State of posterolateral corner • Size/position of footprint and diameter of ligament for ACL reconstruction PARTIAL TEARS Some ACL's do not look frankly ruptured, but appear discontinuous, kinked or otherwise abnormal. Ramp lesions are difficult to diagnose in imaging modality and are under-recognized when using standard anterolateral and anteromedial arthroscopic portals even with probe test. Negative predictive value was 91.1–97.4%, while positive predictive value was 50.0– 90.0%. ment (ACL) lesion (t ermed “ Ramp Lesion ”,b yS t r o b e l et al. 49, no. March 8, 2018. 2021 Mar 12;10(4):e1073-e1077. Epub 2017 Mar 25. Originally, a ramp lesion was defined as a longitudinal tear of the peripheral attachment of the posterior horn of the medial meniscus at the meniscocapsular junction of less than 2.5 cm in length. ↖ read less. A ramp lesion may not be a ligamentous injury because the meniscotibial ligament was not detected. Results: Sixteen ramp lesions were noted on arthroscopy (37.2%). Meniscal ramp lesions have been defined as longitudinal vertical peripheral tears of the medial meniscus involving the posterior meniscocapsular ligament, meniscotibial ligament, and/or the red-red zone of the posterior horn. Sensitivity of detecting a ramp lesion on MRI ranged from 53.9 to 84.6%, while specificity was 92.3–98.7%. Thank you. doi: 10.1016/j.otsr.2017.08.003. Ramp lesions, which are commonly associated with ACL injuries and are often misdiagnosed, 1 disrupt the meniscotibial ligament and the posteromedial meniscus in the meniscocapsular zone. Copyright © 2021 Elsevier B.V. or its licensors or contributors. young patient with chronic ACL deficient knee. Therefore, to rule out a ramp lesion, an They also often remain undiagnosed when viewing from the standard anterior compartment arthroscopic portals. "MRI Appearance of the Different Meniscal Ramp Lesion Types, With Clinical and Arthroscopic Correlation." Greif, Dylan N., et al. Medial meniscus ramp lesion repair with knee scorpion suture device from posteromedial portal in a ... read more ↘. Arthroscopic meniscal repair with use of the outside-in technique. 2019 Nov;47(13):3195-3202 Conclusion A meniscal ramp lesion was present in 14 of 50 children (28%) undergoing ACLR. abstract = "Background: Meniscal ramp lesions have been defined as longitudinal vertical peripheral tears of the medial meniscus involving the posterior meniscocapsular ligament, meniscotibial ligament, and/or the red-red zone of the posterior horn. Ramp Lesions of the Medial Meniscus (MM) are associated with 9 to 17% of ACL Tears and are seldom recognized on preoperative magnetic resonance imaging (MRI) scans. Hi Folks!RAMP lesion is a "hard to find lesion" on MRI exam and using anterior standard portals during knee arthroscopy.I produced two videos about it. Seven ramp lesions were noted on arthroscopy (9%). 8600 Rockville Pike These lesions are very peripherally located in the synovial sheath. RAMP MRI (23 benign, 61 malignant) and DCE MRI examinations (27 benign, 66 malignant) demonstrated 8.4% vs. 9.3% washout (p=0.36) for benign lesions and 18.5% vs. 17% washout (p=0.66) for malignancies, respectively.There was no difference in the … Clipboard, Search History, and several other advanced features are temporarily unavailable. In the ScienceCast series "Knee", Elmar Herbst regularly assesses new publications in the field of knee surgery and discusses these together with a guest expert. Effect of Meniscocapsular and Meniscotibial Lesions in ACL-Deficient and ACL-Reconstructed Knees: A Biomechanical Study. MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation. Bethesda, MD 20894, Copyright Meniscus Ramp Lesion Repair. Skeletal Radiology, vol. Overlooking such lesions during ACLR may contribute to ongoing instability and higher re-rupture rates in these young patients. With an irregularity of the medial meniscus at the posterior margin on MRI, the sensitivity and specificity were 87.5 and 59.3% at 10° knee flexion and 93.8 and 85.2% at 90° flexion, respectively. Management of traumatic meniscal tear and degenerative meniscal lesions. They are strongly associated with acute and chronic anterior cruciate ligament (ACL) tears. Please enable it to take advantage of the complete set of features! From the Department of Radiology and Orthopedics, University of Wisconsin Hospital and Clinics, 600 Highland Ave, E3/311, Madison, WI 53792. Medial meniscus; Meniscocapsular ligament; Meniscotibial ligament; Posterior horn; Ramp lesions. Improved visualization is the key to achieving good meniscal repair results as it improves diagnosis of … Meta-regression analyses were performed to identify potential sources of heterogeneity. Mobility at probing is very low. They also often remain undiagnosed when viewing from the standard anterior compartment arthroscopic portals. Bivariate and hierarchical summary receiver operating characteristic modeling was used to evaluate the diagnostic performance. ↖ read less. Originally, a ramp lesion was defined as a longitudinal tear of the peripheral attachment of the posterior horn of the medial meniscus at the meniscocapsular junction of less than 2.5 cm in length.26 However, recent literature has sug- Meniscal ramp lesions are a special type of injury that affects the periphery of the posterior horn of the medial meniscus (PHMM) and/or its meniscocapsular attachments. Ramp lesion type V. Get link; Facebook; Twitter; Pinterest; Email; Other Apps; Por Dr Vinícius Chissini Paganella - September 24, 2020 MRI. Altmetric Badge. Further clinicoradiological studies of diagnostic algorithms are needed for identifying ramp lesion, including high-resolution MRI with appropriate knee position. Am J Sports Med. Ramp Lesions of the Medial Meniscus (MM) are associated with 9 to 17% of ACL Tears and are seldom recognized on preoperative magnetic resonance imaging (MRI) scans. The sensitivity of MRI was 57% and the positive predictive value was 40%. Background: The study included 177 consecutive breast lesions (50 benign, 127 malignant) in 162 women. It has been reported to play a key role in the anterior tibial translation the knee joint. The coexistence of ACL rupture and other knee injur- However, due to their location and lack of general knowledge regarding their different types and associated appearances on magnetic resonance imaging, ramp lesions are routinely underreported. The bone bruise involves the posterolateral tibial plateau and mid part of the lateral femoral condyle. Ramp lesions, which are commonly associated with ACL injuries and are often misdiagnosed, 1 disrupt the meniscotibial ligament and the posteromedial meniscus in the meniscocapsular zone. doi: 10.1016/j.eats.2020.12.010. Pivot-shift injury caused by valgus stress to flexed and externally rotated knee. A comprehensive search of the MEDLINE, Web of Science and Scopus databases was … Careful exploration of the posteromedial compartment is strongly recommended. These results are in agreement with the 45.5%, 32.5% and 12.0% of median delayed-phase volume of persistent, plateau and washout curve types, respectively, … 2015 Dec;135(12):1701-6 We use cookies to help provide and enhance our service and tailor content and ads. About this Attention Score In the top … Arner JW, Herbst E, Burnham JM, Soni A, Naendrup JH, Popchak A, Fu FH, Musahl V. Knee Surg Sports Traumatol Arthrosc. Sensitivity of detecting a ramp lesion on MRI ranged from 53.9 to 84.6%, while specificity was 92.3–98.7%. To demonstrate MRI appearances and arthroscopic findings of the different types of meniscal ramp lesions, in the hopes of improving their detection on pre-operative imaging. 2021 Mar;216(3):791-798. doi: 10.2214/AJR.20.23389. Accessibility MRI can accurately detect meniscal ramp lesions of the knee. Negative predictive value was 91.1–97.4%, while … Materials and methods Fifty-seven subjects with ACL tears (32 … 2017. 677-689. FOIA MRI. Greif DN, Baraga MG, Rizzo MG, et al. The findings are analyzed, classified and interpreted in the scientific context. Double vertical tear seen in posterior horn medial meniscus. 2012 Oct;40(10):2342-7 Anecdotally, we have found that musculoskeletal radiologists are often unaware of the MRI pattern of this, occasionally subtle, injury to the sMCL of the knee and the associated surgical implications. https://doi.org/10.1016/j.acra.2021.02.005. 2017 Dec;103(8S):S237-S244. Am J Sports Med. 12 Dynamic Sonographic Visualization of an Occult Posterior Lateral Meniscocapsular Separation: A Case Report Purpose: Enjoy a differentiated dialogue in a highly efficient short video format and stay up-to-date. With an irregularity of the medial meniscus at the posterior margin on MRI, the sensitivity and specificity were 87.5 and 59.3% at 10° knee flexion and 93.8 and 85.2% at 90° flexion, respectively. Click on READ MORE button to enlarge images and click on the SUBSCRIBE button to receive e-mail updates. National Library of Medicine The medial meniscus plays a crucial role in restraining posterior translation of the medial femoral condyle on the tibia. [ 77 ]) still rema ins an understudi ed topic. Rampenläsionen sind häufig mit Verletzungen des vorderen Kreuzbands (VKB) vergesellschaftet und treten fast ausschließlich im Bereich des medialen Meniskus auf. However, due to their location and lack of general knowledge regarding their different types and associated appearances on magnetic resonance imaging, ramp lesions are routinely underreported. Epub 2021 Jan 13. Altogether, the prevalence of ramp lesions in this population was 40%. 3): Type 1 : Meniscocapsular lesions. Prevention and treatment information (HHS). Inter-rater reliability between three reviewers was moderate at 0.56. (e-mail: hrosas@uwhealth.org ). Tears involving the posterior meniscocapsular zone, including at the meniscocapsular junction, are also termed “Ramp” lesions, first described by Strobel et al in the 1980s 1. Radiological cases of daily practice including magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET/CT) and X-Rays, without wasting time in your routine. Meniscal ramp lesions are a special type of injury that affects the periphery of the posterior horn of the medial meniscus (PHMM) and/or its meniscocapsular attachments. Ramp lesion Browsing. Knee; Joelho MRI. Results: Sixteen ramp lesions were noted on arthroscopy (37.2%). Results. Diagnostic performance studies using MRI as the index test and arthroscopy as the reference standard for ramp lesion were included. Ramp lesions, whose name reflects the ramp-like appearance of the posteromedial zone, are a particular type of injury within the posterior horn of the medial meniscus and its meniscocapsular attachments [ 3 ]. Careers. 47, No. They are heavily associated with anterior cruciate ligament injuries, and because of their potentially important biomechanical role in knee stabilization, injuries to this region may require surgical repair. Ramp lesions, which are commonly associated with ACL injuries and are often misdiagnosed, 1 disrupt the meniscotibial ligament and the posteromedial meniscus in the meniscocapsula Orthop Traumatol Surg Res. These lesions are stable and can be diagnosed only by a trans-notch approach. Findings of irregularity at the posterior margin (p = 0.001) and complete fluid filling between the posterior horn of the medial meniscus and the capsule margin (p = 0.004) on magnetic resonance imaging were significantly associated with the presence of a ramp lesion. The MFL was not observed in five (19%) of 26 studies of an LMRT. Findings of irregularity at the posterior margin (p = 0.001) and complete fluid filling between the posterior horn of the medial meniscus and the capsule margin (p = 0.004) on magnetic resonance imaging were significantly associated with the presence of a ramp lesion. SAG PD FS. Discussion: Pivot-shift injury caused by valgus stress to flexed and externally rotated knee. Address correspondence to H.G.R. Findings of irregularity at the posterior margin (p = 0.001) and complete fluid filling between the posterior horn of the medial meniscus and the capsule margin (p = 0.004) on magnetic resonance imaging were significantly associated with the presence of a ramp lesion. Would you like email updates of new search results? These lesions have gained much prominence in recent years, due to a significant increase in their diagnosis and their important biomechanical involvement in the knee. 2018 Aug;46(10):2422-2431. doi: 10.1177/0363546518774315. Ramp Lesions (RL) are also often described as meniscocapsular separations and meniscosynovial tears [ 13 ]. DePhillipo NN, Moatshe G, Brady A, Chahla J, Aman ZS, Dornan GJ, Nakama GY, Engebretsen L, LaPrade RF. By sheetal gupta 3 Videos FEATURING sheetal gupta. Knees noted to have a ramp lesion were significantly more likely to have MRI findings of a medial meniscus tear (p=0.005), peripheral meniscal irregularity (p=0.001), junctional T2-weighted signal (p<0.001), and meniscocapsular ligament tear (p<0.001). The bone bruise involves the posterolateral tibial plateau and mid part of the lateral femoral condyle. Meniscal Ramp lesions are frequently associated with Anterior Cruciate Ligament ruptures. By continuing you agree to the use of cookies. With the irregularity at the posterior margin, sensitivity was 86% and … ramp lesion - a specific medial meniscus subtype; radial tear: perpendicular to both the tibial plateau and the long axis of the meniscus; root tear: typically radial-type tear located at the meniscal root; complex tear: a combination of all or some horizontal, vertical, and radial-type tears AX PD FS. Findings of irregularity at the posterior margin (p = 0.001) and complete fluid filling between the posterior horn of the medial meniscus and the capsule margin (p = 0.004) on magnetic resonance imaging were significantly associated with the presence of a ramp lesion. Magnetic resonance imaging (MRI) scans have been reported to have a low sensitivity, and consequently, ramp lesions often go undiagnosed. MRI has a low sensitivity for diagnosis of ramp lesions in children. -, Knee Surg Sports Traumatol Arthrosc. -, Arch Orthop Trauma Surg. Results: Seven ramp lesions were noted on arthroscopy (9%). young patient with chronic ACL deficient knee. The latter type of lesion is called a "hidden lesion." By reducing scan time, the RAMP MRI protocol improves patient comfort and enhances workflow efficiency and can … Meta-regression analyses were performed to identify potential sources of heterogeneity. Get link; Facebook; Twitter; Pinterest; Email; Other Apps; Comments. Save the meniscus. Medial meniscus ramp lesion repair with knee scorpion suture device from posteromedial portal in a ... read more ↘. Knee Surg Sports Traumatol Arthrosc. Meniscal ramp lesions are a type of meniscal injury that have gained prominence in recent years, probably because they are more frequent than previously thought and because of their important biomechanical involvement in ACL-deficient knees, which has recently been demonstrated. 2000 Sep;216(3):851-7 Lateral meniscus extrusion was present in six (23%) of 26 LMRTs and five (2.2%) of 231 patients with normal meniscus roots ( P < .001). The study also reported that younger patients more commonly have ramp lesions and recommend routine evaluation with a posteromedial viewing portal, as implications in missing a ramp lesion may be significant . It is known that their presence in ACL-deficient knees is related to instability and if they are not repaired during ACL reconstruction, they can ultimately cause the failure of the graft. This site needs JavaScript to work properly. They are heavily associated with anterior cruciate ligament injuries, and because of their potentially important biomechanical role in knee … November 24, 2019 RAMP lesion of knee is menisco-capsular separation of medial meniscus and needs to be repaired... read more ↘ 4 Comments . With the extreme forces and altered biomechanics that result in ACL disruption, it is not surprising that associated meniscal tears are extremely common. Diagnostic performance studies using MRI as the index test and arthroscopy as the reference standard for ramp lesion were included. Results: Seven ramp lesions were noted on arthroscopy (9%). Ramp lesions may be classified into 5 types according to their morphology ( Fig. Arthrosc Tech. Others demonstrate enlarged sheaths with fibres separated by fluid material. Conversely, 12 patients had a ramp lesion detected on the MRI, which could not be confirmed intraoperatively. Published by Elsevier Inc. All rights reserved. Epub 2018 May 30. had arthroscopy-confirmed ramp lesions, while the other 77 had other meniscal pathology. A ramp lesion is a disruption in the meniscocapsular attachments of the medial meniscus (MM) posterior horn (PH) and is characterized by a superior meniscocapsular or inferior meniscotibial ligament tear, or both [ 1, 2, 3, 4, 5 ]. MRI Criteria for Meniscal Ramp Lesions of the Knee in Children With Anterior Cruciate Ligament Tears. Pivot shift knee injury- ACL tear and Ramp meniscal lesion. By Alper Kaya 4 Videos. 5, 2020, pp. They are heavily associated with anterior cruciate ligament injuries, and because of their potentially important biomechanical role in knee stabilization, … Meniscal Ramp Lesions: What the Radiologist Needs to Know. A meniscal ramp lesion was present in 14 of 50 children (28%) undergoing ACLR. Login to view comments. -. This is compounded by the fact that ramp lesions are also often overlooked during conventional anterior portal arthroscopy when direct visualization is not achieved. MR Imaging–based Diagnosis and Classification of Meniscal Tears. Overview of attention for article published in Skeletal Radiology, January 2020. sports injury knee sports radiology Posterior meniscal ramp lesions: insufficiently known or underestimated? ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Meniscal Ramp Lesions: What the Radiologist Needs to Know. Keywords: It has been reported to play a key role in the anterior tibial translation the knee joint. Nguyen JC, Bram JT, Lawrence JTR, Hong S, Leska TM, Ganley TJ, Ho-Fung V. AJR Am J Roentgenol. 2015 Oct;23(10):2967-73 Meniscal Ramp lesions are frequently associated with Anterior Cruciate Ligament ruptures. Stratified subgroup analysis and multivariable regression analysis were performed to identify factors … Malignant lesions in our RAMP protocol (delayed phase at 180–205 seconds after contrast injection) demonstrated 46.0%, 33.0% and 11.0% of median delayed-phase lesion volume of persistent, plateau and washout curve types, respectively. 26 However, recent literature has suggested that ramp lesions are associated with injury to the meniscotibial ligament attachment of the posterior horn of the medial meniscus. -, Am J Sports Med. MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation. Im Rahmen einer anterioren Routinekniegelenkspiegelung und durch die präoperative radiologische Diagnostik können sie nur eingeschränkt bis gar nicht diagnostiziert werden. Conclusion: Lesion kinetic analyses from the RAMP MRI protocol can achieve the same discriminatory ability as the full DCE protocol. Knees in which a ramp lesion was observed were significantly more likely to have MRI findings of a medial meniscus tear (p = .005), peripheral meniscal irregularity (p = .001), junctional T2-weighted signal (p < .001), and a meniscocapsular ligament tear (p < .001). Improved visualization is the key to achieving good meniscal repair … Meniscal tear | Radiology Reference Article | Radiopaedia.org Disruption of the posterior horn of the medial meniscus could lead to excessive forces within the knee joint and surrounding structures. Meniscus Ramp Lesion. Acute ACL tears have a reported incidence of meniscal tear in up to 82% of cases, and chronic ACL tears have a reported incidence of meniscal tear in up to 96% of cases. 2017 Dec;25(12):3955-3960. doi: 10.1007/s00167-017-4523-9. Unable to load your collection due to an error, Unable to load your delegates due to an error. PMID: 31684739 Medial Meniscal Ramp Lesion Repair Through Anterior Portals Using a Medial Collateral Ligament Pie-Crusting Technique. Post a Comment. Background Meniscal ramp lesions have been defined as longitudinal vertical peripheral tears of the medial meniscus involving the posterior meniscocapsular ligament, meniscotibial ligament, and/or the red-red zone of the posterior horn.
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