Abstract
PurposeWe conducted a systematic review of the published literature to assess the accuracy of Magnetic Resonance Imaging (MRI) in establishing the presence of ramp lesions (RLs) in Anterior Cruciate Ligament (ACL) deficient knees and the clinical efficacy of the surgical repair of RLs.MethodsA comprehensive search of the MEDLINE, Web of Science and Scopus databases was performed according to PRISMA guidelines. Studies assessing MRI diagnostic accuracy for RLs or the clinical effect of RL repair in participants with ACL injuries were included. Diagnostic accuracy measures were pooled and plotted in forest plots. Preoperative and at last follow-up treatment efficacy outcome measures were extracted and plotted in forest plots, for graphical comprehension.ResultsSixteen studies met the criteria and were included. The diagnostic analysis showed a pooled sensitivity, specificity, positive and negative likelihood ratios of 65.1% (95% CI, 59.73 to 70.42), 91.6% (95% CI, 89.14 to 94.05), 2.91 (95% CI, 2.38–3.55) and 0.53 (95% CI, 0.44–0.64), respectively, with high heterogeneity (I2 above 80%) for all measures. Treatment analysis showed improved Lysholm Knee Score, IKDC score and laxity difference between the knees in all studies after meniscal suture repair. A separate analysis showed no differences between repair of smaller, stable, RLs with meniscal sutures and repair with abrasion and trephination only.ConclusionAlthough the results present considerable heterogeneity, MRI seems to demonstrate moderate accuracy in the diagnosis of RLs in patients with ACL tear and the surgical repair of RLs can be associated with improved overall outcomes.
Highlights
Described in 1983 by Hamberg et al [30], injury to the peripheral attachment of the posterior horn of the medial meniscus (PHMM) after Anterior Cruciate Ligament (ACL) lesion still remains an understudied topic.The coexistence of ACL rupture and other knee injuries has been described in many studies
A total of 16 original research articles were included in the systematic review, eight studies were included in the diagnostic analysis and nine studies were included in the treatment analysis, with one study [28] being included in both portions
The results of this review demonstrated that Magnetic Resonance Imaging (MRI) has a moderate sensitivity (65%) and a high specificity (92%) in the diagnosis of Ramp Lesions (RL)
Summary
Described in 1983 by Hamberg et al [30], injury to the peripheral attachment of the posterior horn of the medial meniscus (PHMM) after Anterior Cruciate Ligament (ACL) lesion (termed “Ramp Lesion”, by Strobel et al [77]) still remains an understudied topic. The coexistence of ACL rupture and other knee injuries has been described in many studies. Acute ACL rupture is associated with a meniscal injury in over 50% (16–82%, in different studies) of injuries and over 80% of chronic ACL ruptures [10, 29, 35, 49, 62, 82, 83]. Recent literature has extended the definition to include injuries of the meniscotibial ligament and peripheral longitudinal tears in the Red-Red zone of the PHMM [12, 13, 60, 72, 79, 80] and different classification systems have been proposed by Thaunat et al [79] and Seil et al [64]. Incidence ranges from 9% to 40% in many small population studies, becoming higher with chronicity of ACL
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
