Excessive anterior tibial translation in the contralateral uninjured limb is significantly associated with ramp lesion in anterior cruciate ligament injury

Kazuki Asai,Mitsuhiro Kimura,Rikuto Yoshimizu,Junsuke Nakase,Hiroyuki Tsuchiya

doi:10.1186/s40634-021-00372-9

Abstract

PurposeThis study aimed to evaluate the excessive anterior tibial translation (ATT) and muscle strength of patients with ramp lesions. We hypothesised that the higher ATT, lower hamstring-to-quadriceps (HQ) ratio, and higher flexion peak torque influenced by semimembranosus would be associated with ramp lesions.MethodsOne hundred and twenty-one patients who underwent anterior cruciate ligament (ACL) reconstruction were retrospectively evaluated. Clinical evaluation included ATT of the contralateral uninjured limb measured using a KT-1000 arthrometer, the knee flexor and extensor muscle strength of the contralateral uninjured limb at 60°/s and 180°/s of an angular velocity measured using an isokinetic dynamometer, and HQ ratio at 60°/s and 180°/s during the preoperative state. Binary stepwise logistic regression analysis was performed to evaluate the risk factors of ramp lesions.ResultsRamp lesions were found in 27 cases of ACL injuries (27/121, 22.3%). Male sex (odds ratio [OR], 2.913; 95% confidence interval [CI], 1.090–7.787; P = 0.033), longer time between injury to surgery (OR, 2.225; 95% CI, 1.074–4.608; P = 0.031), and higher ATT in the contralateral uninjured limb (OR, 1.502; 95% CI, 1.046–2.159; P = 0.028) were indicated as the independent risk factors of the presence of ramp lesion associated with an ACL injury.ConclusionsMale sex, longer period from injury to surgery, and higher ATT in the contralateral uninjured limb were significantly associated with ramp lesion. These findings are advantageous for identifying patients with a greater risk of developing a ramp lesion with an ACL injury in the clinical setting.Level of evidenceLevel IV

Highlights

Ramp lesion is a specific type of meniscus lesion such as a meniscocapsular tear of the posterior horn of the medial meniscus (PHMM) associated with anterior cruciate ligament (ACL) injury, which is called a “hidden lesion” [18].Ramp lesions accounted for 9%–24% of all ACL injuries [2, 10, 19]
Risk factors of ramp lesions On logistic regression analysis, male sex, longer time from injury to surgery (OR, 2.225; 95% confidence interval (CI), 1.074–4.608; P = 0.031), and higher anterior tibial translation (ATT) in the contralateral uninjured limb (OR, 1.502; 95% CI, 1.046– 2.159; P = 0.028) were indicated as independent risk factors for the presence of ramp lesions associated with ACL injury (Table 2)
On logistic regression analysis, male sex, long time from injury to surgery, and higher ATT in the contralateral uninjured limb were significantly associated with ramp lesions

Summary

Introduction

Ramp lesion is a specific type of meniscus lesion such as a meniscocapsular tear of the posterior horn of the medial meniscus (PHMM) associated with anterior cruciate ligament (ACL) injury, which is called a “hidden lesion” [18]. Ramp lesions accounted for 9%–24% of all ACL injuries [2, 10, 19]. Some studies have reported that longer time from injury to surgery, young age, and contact injury mechanism were risk factors for ramp lesions [1, 10, 19]. George et al reported that the presence of bone marrow oedema of the posteromedial tibia or a lateral meniscal tear was associated with the presence of ramp lesions [1]. The mechanism and risk factors of ramp lesions remain unclear.

Objectives

Methods

Results

Discussion

Conclusion