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Ramp lesions are six times more likely to be observed in the presence of a posterior medial tibial bone bruise in ACL-injured patients

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to determine whether posterior tibial slope (PTS), meniscal slope (MS), and bone bruise pattern (BBP), as observed on magnetic resonance imaging (MRI), differed between patients with or without medial meniscus ramp lesions at the time of anterior cruciate ligament reconstruction (ACLR). The hypothesis was that patients with a ramp lesion had a higher PTS and MS, with a different BBP than patients without a ramp lesion.

Methods

Fifty-six patients undergoing ACLR were selected from an in-house registry and separated into 2 groups: (1) the RAMP group included patients with a primary ACLR and a medial meniscus ramp lesion diagnosed intraoperatively; (2) the CONTROL group included patients with a primary ACLR without ramp lesion after arthroscopic exploration of the posteromedial knee area. The two groups were matched for age, sex and type of concomitant meniscal lesions. The medial/lateral-PTS/MS and BBP were subjected to blinded evaluation on the preoperative MRI of the reconstructed knee.

Results

Twenty eight patients (21 males; 7 females) were included in each group. No significant difference could be observed between groups in terms of demographical characteristics, PTS, and MS. A posteromedial tibial plateau (PMTP) bone bruise was more often observed in the RAMP group (n = 23/28) compared to the CONTROL group (n = 12/28) (p < 0.01). The RAMP group was 6.1 (95%CI [1.8; 20.8]) times more likely to present a PMTP bone bruise. The likelihood of having a bone bruise in both the medial and lateral compartments was 4.5 (95%CI [1.2; 16.5]) times higher in the RAMP group. However, a BBP only involving the lateral tibiofemoral compartment was more likely to be observed in the CONTROL group (n = 10/28) compared to the RAMP group (n = 3/28, p < 0.05 – odds ratio 4.6 (95%CI [1.1; 19.2]).

Conclusion

Ramp lesions were 6.1 and 4.5 times more likely to be observed in the presence of a posteromedial tibia plateau bone bruise or a combined bone bruise respectively in both the medial and lateral tibiofemoral compartment in patients undergoing ACLR. The tibial and meniscal slopes did not differ between patients with or without ramp lesions undergoing ACLR.

Level of evidence

Level III

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Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

ALTP:

Anterolateral tibial plateau

AMTP:

Anteromedial tibia plateau

BBP:

Bone bruise pattern

BMI:

Body Mass Index

ICC:

Intraclass correlation coefficient

IQR:

The Interquartile Range

LBBBP:

Lateral and medial bone bruise pattern

LBBP:

Lateral bone bruise pattern

LFC:

Lateral femoral condyle

MBBP:

Medial bone bruise pattern

MFC:

Medial femoral condyle

MRI:

Magnetic resonance imaging

MS:

Meniscal slope

PLTP:

Posterolateral tibia plateau

PMTP:

Posteromedial tibial plateau

PTS:

Posterior tibial slope

SD:

Standard deviation

SEM:

Standard-error-measurement

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Acknowledgements

We have no acknowledgements to report.

Funding

No funding has been received to conduct the study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg–Clinique d’Eich, 78, rue d’ Eich, 1460, Luxembourg City, Luxembourg

    Wouter Beel, Caroline Mouton & Romain Seil

  2. Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg City, Luxembourg

    Caroline Mouton, Christian Nührenbörger & Romain Seil

  3. Department of Orthopaedic Surgery, Hospital San Raffaele, Milan, Italy

    Daniele Tradati

  4. Department of Sports Medicine, Centre Hospitalier de Luxembourg–Clinique d’Eich, Luxembourg City, Luxembourg

    Christian Nührenbörger

  5. Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg City, Luxembourg

    Romain Seil

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  1. Wouter Beel
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  4. Christian Nührenbörger
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Contributions

WB has co-designed the study; Investigated the MRI's for posterior tibial and meniscal slope, and bone bruise appearance; Analyzed and interpreted the data; the main drafter of the manuscript. CM is co-designer of the study; retrieved and provided the data from the in-house registry; participated in the data analysis; involved in drafting and revision of the manuscript. DT contributed to the MRI investigation method; revised the manuscript CN contributed in the acquisition of the patient’s preoperative data; revised the manuscript. RS contributed in the study design; as primary surgeon in all patients, he collected the intraoperative patient's data; critically revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Romain Seil.

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Conflict of interest

All authors declared that they have no conflict of interest.

Ethical approval

Institutional Review Board approval for the study protocol has been given by the National Ethics Committee for Research in Luxemburg (Comité National d'Ethique de Recherche, notification number 201101/05).

Informed consent

All patients gave their written informed consent to participate in the study.

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Beel, W., Mouton, C., Tradati, D. et al. Ramp lesions are six times more likely to be observed in the presence of a posterior medial tibial bone bruise in ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 30, 184–191 (2022). https://doi.org/10.1007/s00167-021-06520-z

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