Skip to main content
SpringerLink
Log in

The crevice sign: a new indicator of meniscal instability in ACL reconstructions

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Meniscus preservation is key in knee surgery. The newly documented crevice sign indicates instability of the medial meniscus in ACL-deficient knees. Once the sign is visualised, it is imperative that the stability of the medial meniscus is assessed and potentially treated. It was hypothesized that there would be a strong correlation between the presence of an unstable medial meniscal tear in patients with the crevice sign in ACL-deficient knees.

Methods

This was a multicenter prospective study carried out to evaluate the incidence of medial meniscal tears in patients with ACL-deficient knees and their correlation with a crevice sign. All patients (128) who had undergone ACL reconstruction between May 2020 and November 2020 were assessed arthroscopically for meniscal stability and divided in to two groups: stable (n = 84) and unstable (n = 44). Thereafter, the presence of the crevice sign was determined in each case.

Results

The populations were comparable in terms of sex and age (Table 1). Fisher’s exact test showed a significant association between the presence of the crevice sign and the instability of the medial meniscus (p < 0.001). Descriptive statistics suggest that the presence of crevice sign was associated more frequently to MM instability (38.6% vs 1.2%; p < 0.001). The specificity of this test was 98.8% and its sensitivity was 38.6%. The positive predictive value (PPV) was 94.4% and the negative predictive value (NPV) was 75.5%.

Table 1 Descriptions and comparisons of internal meniscus instability of patients by presence of crevice sign
Full size table

Conclusion

The hypothesis was confirmed since medial meniscal instability was strongly correlated with the existence of the crevice sign and showed high specificity and PPV.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Batty L, Murgier J, O’Sullivan R, Webster KE, Feller JA, Devitt BM (2019) The Kaplan fibers of the iliotibial band can be identified on routine knee magnetic resonance imaging. Am J Sports Med 47:2895–2903

    Article  Google Scholar 

  2. Batty LM, Murgier J, Feller JA, O’Sullivan R, Webster KE, Devitt BM (2020) Radiological identification of injury to the kaplan fibers of the iliotibial band in association with anterior cruciate ligament injury. Am J Sports Med 48:2213–2220

    Article  Google Scholar 

  3. Cavaignac E, Sylvie R, Teulieres M, Fernandez A, Frosch KH, Gomez-Brouchet A et al (2021) What is the relationship between the distal semimembranosus tendon and the medial meniscus? A gross and microscopic analysis from the SANTI Study Group. Am J Sports Med 49:459–466

    Article  Google Scholar 

  4. Choi KY, Koh IJ, Kim MS, In Y (2021) Medial meniscal ramp lesion repair through anterior portals using a medial collateral ligament pie-crusting technique. Arthrosc Tech 10:e1073–e1077

    Article  Google Scholar 

  5. Claes S, Hermie L, Verdonk R, Bellemans J, Verdonk P (2013) Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc 21:1967–1976

    Article  Google Scholar 

  6. Cristiani R, Parling A, Forssblad M, Edman G, Engstrom B, Stalman A (2020) Meniscus repair does not result in an inferior short-term outcome compared with meniscus resection: an analysis of 5378 patients with primary anterior cruciate ligament reconstruction. Arthroscopy 36:1145–1153

    Article  Google Scholar 

  7. DePhillipo NN, Moatshe G, Chahla J, Aman ZS, Storaci HW, Morris ER et al (2019) Quantitative and qualitative assessment of the posterior medial meniscus anatomy: defining meniscal ramp lesions. Am J Sports Med 47:372–378

    Article  Google Scholar 

  8. Geffroy L (2021) Meniscal pathology in children and adolescents. Orthop Traumatol Surg Res 107:102775

    Article  Google Scholar 

  9. Hatayama K, Terauchi M, Saito K, Takase R, Higuchi H (2020) healing status of meniscal ramp lesion affects anterior knee stability after ACL reconstruction. Orthop J Sports Med 8:2325967120917674

    Article  Google Scholar 

  10. Inoue H, Furumatsu T, Miyazawa S, Fujii M, Kodama Y, Ozaki T (2018) Improvement in the medial meniscus posterior shift following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26:434–441

    Article  Google Scholar 

  11. Jacquet C, Pujol N, Pauly V, Beaufils P, Ollivier M (2019) Analysis of the trends in arthroscopic meniscectomy and meniscus repair procedures in France from 2005 to 2017. Orthop Traumatol Surg Res 105:677–682

    Article  Google Scholar 

  12. Kanto R, Yamaguchi M, Sasaki K, Matsumoto A, Nakayama H, Yoshiya S (2019) Second-look arthroscopic evaluations of meniscal repairs associated with anterior cruciate ligament reconstruction. Arthroscopy 35:2868–2877

    Article  Google Scholar 

  13. Kedgley AE, Saw TH, Segal NA, Hansen UN, Bull AMJ, Masouros SD (2019) Predicting meniscal tear stability across knee-joint flexion using finite-element analysis. Knee Surg Sports Traumatol Arthrosc 27:206–214

    Article  Google Scholar 

  14. Kunze KN, Rossi DM, White GM, Karhade AV, Deng J, Williams BT et al (2021) Diagnostic performance of artificial intelligence for detection of anterior cruciate ligament and meniscus tears: a systematic review. Arthroscopy 37:771–781

    Article  Google Scholar 

  15. Laurens M, Cavaignac E, Fayolle H, Sylvie R, Lapegue F, Sans N et al (2021) The accuracy of MRI for the diagnosis of ramp lesions. Skeletal Radiol. https://doi.org/10.1007/s00256-021-03858-w

    Article  PubMed  Google Scholar 

  16. Magosch A, Mouton C, Nuhrenborger C, Seil R (2020) Medial meniscus ramp and lateral meniscus posterior root lesions are present in more than a third of primary and revision ACL reconstructions. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06352-3

    Article  PubMed  Google Scholar 

  17. Murgier J, Hansom D, Clatworthy M (2020) Knee arthroscopy: the “crevice sign,” a new pathognomonic sign for unstable posterior medial meniscal tear in anterior cruciate ligament-deficient knees. Arthrosc Tech 9:e263–e265

    Article  Google Scholar 

  18. Murgier J, Powell A, Young S, Clatworthy M (2021) Effectiveness of thicker hamstring or patella tendon grafts to reduce graft failure rate in anterior cruciate ligament reconstruction in young patients. Knee Surg Sports Traumatol Arthrosc 29:725–731

    Article  Google Scholar 

  19. Muriuki MG, Tuason DA, Tucker BG, Harner CD (2011) Changes in tibiofemoral contact mechanics following radial split and vertical tears of the medial meniscus an in vitro investigation of the efficacy of arthroscopic repair. J Bone Jt Surg Am 93:1089–1095

    Article  CAS  Google Scholar 

  20. Neuman P, Englund M, Kostogiannis I, Friden T, Roos H, Dahlberg LE (2008) Prevalence of tibiofemoral osteoarthritis 15 years after nonoperative treatment of anterior cruciate ligament injury: a prospective cohort study. Am J Sports Med 36:1717–1725

    Article  Google Scholar 

  21. Okazaki Y, Furumatsu T, Miyazawa S, Kodama Y, Kamatsuki Y, Hino T et al (2019) Meniscal repair concurrent with anterior cruciate ligament reconstruction restores posterior shift of the medial meniscus in the knee-flexed position. Knee Surg Sports Traumatol Arthrosc 27:361–368

    Article  Google Scholar 

  22. Ozeki N, Seil R, Krych AJ, Koga H (2021) Surgical treatment of complex meniscus tear and disease: state of the art. J ISAKOS 6:35–45

    Article  Google Scholar 

  23. Pujol N, Beaufils P (2019) Save the meniscus again! Knee Surg Sports Traumatol Arthrosc 27:341–342

    Article  Google Scholar 

  24. Qalib YO, Tang Y, Wang D, Xing B, Xu X, Lu H (2021) Ramp lesion of the medial meniscus. EFORT Open Rev 6:372–379

    Article  Google Scholar 

  25. Sarraj M, Coughlin RP, Solow M, Ekhtiari S, Simunovic N, Krych AJ et al (2019) Anterior cruciate ligament reconstruction with concomitant meniscal surgery: a systematic review and meta-analysis of outcomes. Knee Surg Sports Traumatol Arthrosc 27:3441–3452

    Article  Google Scholar 

  26. Seon JK, Gadikota HR, Kozanek M, Oh LS, Gill TJ, Li G (2009) The effect of anterior cruciate ligament reconstruction on kinematics of the knee with combined anterior cruciate ligament injury and subtotal medial meniscectomy: an in vitro robotic investigation. Arthroscopy 25:123–130

    Article  Google Scholar 

  27. Sonnery-Cottet B, Praz C, Rosenstiel N, Blakeney WG, Ouanezar H, Kandhari V et al (2018) Epidemiological evaluation of meniscal ramp lesions in 3214 anterior cruciate ligament-injured knees from the santi study group database: a risk factor analysis and study of secondary meniscectomy rates following 769 ramp repairs. Am J Sports Med 46:3189–3197

    Article  Google Scholar 

  28. Sonnery-Cottet B, Serra Cruz R, Vieira TD, Goes RA, Saithna A (2020) Ramp lesions: an unrecognized posteromedial instability? Clin Sports Med 39:69–81

    Article  Google Scholar 

  29. Totlis T, Haunschild E, Otountzidis N, Stamou K, Condron NB, Tsikopoulos K et al (2021) Return to sport rate and activity level are high following arthroscopic all-inside meniscal repair with and without concomitant ACL reconstruction: a systematic review. Arthroscopy. https://doi.org/10.1016/j.arthro.2021.02.046

    Article  PubMed  Google Scholar 

  30. Vieira TD, Blakeney WG, Canuto S, Cavaignac E, Claes S, Daggett M et al (2020) Effect of meniscal ramp lesion repair on knee kinematics, bony contact forces, and in situ forces in the anterior cruciate ligament: letter to editor. Am J Sports Med 48:NP23–NP25

    Article  Google Scholar 

Download references

Funding

No funding was received to support this work.

Author information

Authors and Affiliations

  1. Clinique Aguiléra, Ramsay Santé, Service de chirurgie orthopédique, 21 rue de l’Estagnas, 64200, Biarritz, France

    Jérôme Murgier

  2. South France Knee Association, 66330, Cabestany, France

    Jérôme Murgier & Xavier Bayle-Iniguez

  3. Clinique Médipôle Saint-Roch, Elsan, Service de chirurgie orthopédique, 66330, Cabestany, France

    Xavier Bayle-Iniguez

  4. Department of Orthopaedics, Middlemore Hospital, 100 Hospital Rd, Otahuhu, Auckland, 2025, New Zealand

    Mark Clatworthy

Authors
  1. Jérôme Murgier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xavier Bayle-Iniguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark Clatworthy
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JM designed the study and wrote the article. XBI and MC designed the study and provided critical revisions of the article.

Corresponding author

Correspondence to Jérôme Murgier.

Ethics declarations

Conflict of interest

JM has no conflicts of interest to declare. XBI has no conflict of interest to declare. MC reports financial support from Arthrex and personal fees from Johnson & Johnson outside of the submitted work.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 85985 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Murgier, J., Bayle-Iniguez, X. & Clatworthy, M. The crevice sign: a new indicator of meniscal instability in ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 30, 1888–1892 (2022). https://doi.org/10.1007/s00167-021-06823-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-021-06823-1

Keywords

Search

Navigation