Abstract
BackgroundThe posteromedial meniscal region is gaining interest among orthopedic surgeons, as lesions of this area has been reported to be significantly associated with anterior cruciate ligament tears. The current imaging literature is unclear.PurposeTo evaluate the diagnostic performance of MR in the detection of meniscal ramp lesions having arthroscopy as reference standard.Materials and methodsWe retrospectively included 56 patients (mean age of 25 ± 7 years; 14 females) from January to November 2017 with a arthroscopically proved ACL tear and posterior meniscocapsular separation. On preoperative MRI, two radiologists with 13 and 2 years’ experience in musculoskeletal imaging assessed the presence/absence of ramp lesion, meniscotibial ligament lesion, peripheral meniscal lesion, or their combination, bone bruise. Having arthroscopy as reference standard, diagnostic performance of MRI in the evaluation of ramp area lesions was calculated. Cohen’s kappa (k) and Fisher's Exact Test statistics were used.ResultsAgreement between radiologists ranged from κ = 0.784 (meniscotibial ligament lesions) to κ = 0.918 red–red meniscal lesion. Sensitivities were 97.4% for ramp lesions, 95.8% for meniscotibial ligament lesion, 94.4% for peripheral meniscal lesions; specificities were 88.9%, 81.3%, and 97.4%, respectively; accuracies were 94.6%, 87.5%, and 96.4%, respectively. Agreement between MR and arthroscopy was almost perfect in identification of ramp lesions (κ = 0.871) and red–red zone meniscal lesions (κ = 0.908). The agreement between the two methods was substantial (κ = 0.751) for meniscotibial lesion. No significant association between tibial plateau bone bruise and the different type of lesions was found (κ ≥ 0.004 and p ≥ 0.08).ConclusionMR has high diagnostic performance in meniscal ramp area lesion assessment, with substantial to almost perfect inter-reader agreement.
Highlights
The posteromedial region of the meniscus is gaining increasing interest among orthopedic surgeons, as lesions of this area have been reported to be significantly associated with anterior cruciate ligament tears, with implications for patients’ care [1]
If magnetic resonance imaging (MRI) is performed with knee 90° flexed, the superior posteromedial (SPM) recess widens and the inferior posteromedial (IPM) recess collapses, to what happens during arthroscopy
The agreement between the two radiologists was almost perfect for the detection of ramp lesions (κ = 0.908) and red–red meniscal lesion (κ = 0.918)
Summary
The posteromedial region of the meniscus is gaining increasing interest among orthopedic surgeons, as lesions of this area have been reported to be significantly associated with anterior cruciate ligament tears, with implications for patients’ care [1]. If MRI is performed with knee 90° flexed, the SPM recess widens and the IPM recess collapses, to what happens during arthroscopy. The SPM and IPM recesses, the ramp capsule and the meniscotibial ligament, are normally separated by a thin fat pad [4] and Fig. 1a–d, a detail which has been neglected in the orthopedic literature, probably because during arthroscopy this area is covered and dislocated by the capsule. The posteromedial meniscal region is gaining interest among orthopedic surgeons, as lesions of this area has been reported to be significantly associated with anterior cruciate ligament tears. Conclusion MR has high diagnostic performance in meniscal ramp area lesion assessment, with substantial to almost perfect inter-reader agreement
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