Abstract
Purpose
(i) To investigate the frequency and natural evolution of meniscal ramp lesions (MRLs) on MRI in subjects with acute ACL tear and (ii) to compare knee cartilage compositional degeneration between subjects with MRLs and subjects without meniscal pathology over 2 years.
Materials and methods
Fifty-seven subjects with ACL tears (32 females; age 32.6 ± 8.3 years; BMI 24.5 ± 3.5 kg/m2) from a prospective study were screened for the presence of MRLs. Morphological (high-resolution 3D fast spin-echo) and compositional (T1ρ and T2 mapping) MRI was performed prior to and 2 years after ACL reconstruction. Follow-up MR images were assessed for changes in the signal intensity of the MRLs and the presence of meniscal tears. Differences of compositional parameters were compared between subjects with MRLs and without meniscal lesions using independent samples t tests.
Results
MRLs were found in 16% (9/56) of the subjects with ACL tears at baseline. Only one subject with MRLs developed a posterior horn meniscal tear over 2 years. In 12 knees, no meniscal tears were found, which were defined as controls. Most interestingly, cartilage ∆T1ρ of the medial femur and medial tibia increased significantly more in subjects with MRLs compared with controls (mean difference, MF = 6.0 ± 0.8 vs. 2.3 ± 0.6, p = 0.004, and MT = 4.4 ± 1.4 vs. 0.4 ± 0.6, p = 0.027) and medial femur ∆T2 over 2 years increased significantly more in MRL than in control knees (5.1 ± 2.5 ms vs. 2.2 ± 1.9 ms, p = 0.012).
Conclusion
Subjects with ACL tear presented MRLs in 16% of cases. Compared with controls without meniscal lesions, knees with MRLs demonstrated accelerated degeneration of cartilage composition in the medial knee compartment over 2 years.
Similar content being viewed by others
References
Bisson LJ, Kluczynski MA, Hagstrom LS, Marzo JM. A prospective study of the association between bone contusion and intra-articular injuries associated with acute anterior cruciate ligament tear. Am J Sports Med. 2013;41(8):1801–7.
Borchers JR, Kaeding CC, Pedroza AD, et al. Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: a comparison of the MOON and MARS study groups. Am J Sports Med. 2011;39(9):1889–93.
Keene GC, Bickerstaff D, Rae PJ, Paterson RS. The natural history of meniscal tears in anterior cruciate ligament insufficiency. Am J Sports Med. 1993;21(5):672–9.
Strobel MJ. Manual of arthroscopic surgery. Berlin Heidelberg: Springer-Verlag; 2002. https://www.springer.com/gp/book/9783540874102. Accessed May 18, 2020
Chahla J, Dean CS, Moatshe G, et al. Meniscal ramp lesions: anatomy, incidence, diagnosis, and treatment. Orthop J Sports Med. 2016;4(7):2325967116657815.
Lecouvet F, Van Haver T, Acid S, et al. Magnetic resonance imaging (MRI) of the knee: identification of difficult-to-diagnose meniscal lesions. Diagn Interv Imaging. 2018;99(2):55–64.
DePhillipo NN, Moatshe G, Chahla J, et al. Quantitative and qualitative assessment of the posterior medial meniscus anatomy: defining meniscal ramp lesions. Am J Sports Med. 2019;47(2):372–8.
Balazs GC, Greditzer HG, Wang D, et al. Ramp lesions of the medial meniscus in patients undergoing primary and revision ACL reconstruction: prevalence and risk factors. Orthop J Sports Med. 2019;7(5):232596711984350.
Koo B, Lee SH, Yun SJ, Song JG. Diagnostic performance of magnetic resonance imaging for detecting meniscal ramp lesions in patients with anterior cruciate ligament tears: a systematic review and meta-analysis. Am J Sports Med. 2019;036354651988052.
Hetsroni I, Lillemoe K, Marx RG. Small medial meniscocapsular separations: a potential cause of chronic medial-side knee pain. Arthroscopy. 2011;27(11):1536–42.
Keyhani S, Ahn JH, Verdonk R, Soleymanha M, Abbasian M. Arthroscopic all-inside ramp lesion repair using the posterolateral transseptal portal view. Knee Surg Sports Traumatol Arthrosc. 2017;25(2):454–8.
Kim SH, Lee SH, Kim K-I, Yang JW. Diagnostic accuracy of sequential arthroscopic approach for ramp lesions of the posterior horn of the medial meniscus in anterior cruciate ligament-deficient knee. Arthroscopy. 2018;34(5):1582–9.
Malatray M, Raux S, Peltier A, Pfirrmann C, Seil R, Chotel F. Ramp lesions in ACL deficient knees in children and adolescent population: a high prevalence confirmed in intercondylar and posteromedial exploration. Knee Surg Sports Traumatol Arthrosc. 2018;26(4):1074–9.
Stephen JM, Halewood C, Kittl C, Bollen SR, Williams A, Amis AA. Posteromedial meniscocapsular lesions increase tibiofemoral joint laxity with anterior cruciate ligament deficiency, and their repair reduces laxity. Am J Sports Med. 2016;44(2):400–8.
Naendrup JH, Pfeiffer TR, Chan C, Nagai K, Novaretti JV, Sheean AJ, et al. Effect of meniscal ramp lesion repair on knee kinematics, bony contact forces, and in situ forces in the anterior cruciate ligament. Am J Sports Med. 2019;47(13):3195–202.
Vieira TD, Blakeney WG, Canuto S, Cavaignac E, Claes S, Daggett M, et al. 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. 2020;48(2):Np23–Np5.
DePhillipo NN, Moatshe G, Brady A, et al. Effect of meniscocapsular and meniscotibial lesions in ACL-deficient and ACL-reconstructed knees: a biomechanical study. Am J Sports Med. 2018;46(10):2422–31.
Wright RW, Haas AK, Anderson J, Calabrese G, Cavanaugh J, Hewett TE, et al. Anterior cruciate ligament reconstruction rehabilitation: MOON guidelines. Sports Health. 2015;7(3):239–43.
Hash TW. Magnetic resonance imaging of the knee. Sports Health. 2013;5(1):78–107.
Hajek PC, Gylys-Morin VM, Baker LL, Sartoris DJ, Haghighi P, Resnick D. The high signal intensity meniscus of the knee. Magnetic resonance evaluation and in vivo correlation. Investig Radiol. 1987;22(11):883–90.
Li X, Kuo D, Theologis A, et al. Cartilage in anterior cruciate ligament-reconstructed knees: MR imaging T1{rho} and T2--initial experience with 1-year follow-up. Radiology. 2011;258(2):505–14.
Peltier A, Lording T, Maubisson L, Ballis R, Neyret P, Lustig S. The role of the meniscotibial ligament in posteromedial rotational knee stability. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):2967–73.
Bumberger A, Koller U, Hofbauer M, et al. Ramp lesions are frequently missed in ACL-deficient knees and should be repaired in case of instability. Knee Surg Sports Traumatol Arthrosc. 2020;28(3):840–54.
Arner JW, Herbst E, Burnham JM, et al. MRI can accurately detect meniscal ramp lesions of the knee. Knee Surg Sports Traumatol Arthrosc. 2017;25(12):3955–60.
DePhillipo NN, Cinque ME, Chahla J, Geeslin AG, Engebretsen L, LaPrade RF. Incidence and detection of meniscal ramp lesions on magnetic resonance imaging in patients with anterior cruciate ligament reconstruction. Am J Sports Med. 2017;45(10):2233–7.
Liu X, Feng H, Zhang H, Hong L, Wang XS, Zhang J. Arthroscopic prevalence of ramp lesion in 868 patients with anterior cruciate ligament injury. Am J Sports Med. 2011;39(4):832–7.
Thaunat M, Fayard JM, Guimaraes TM, Jan N, Murphy CG, Sonnery-Cottet B. Classification and surgical repair of ramp lesions of the medial meniscus. Arthrosc Tech. 2016;5(4):e871–5.
Liu X, Zhang H, Feng H, Hong L, Wang X-S, Song G-Y. Is it necessary to repair stable ramp lesions of the medial meniscus during anterior cruciate ligament reconstruction? A prospective randomized controlled trial. Am J Sports Med. 2017;45(5):1004–11.
Yeo Y, Ahn JM, Kim H, et al. MR evaluation of the meniscal ramp lesion in patients with anterior cruciate ligament tear. Skelet Radiol. 2018;47(12):1683–9.
Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, LaPrade RF. Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med. 2012;40(10):2342–7.
Øiestad BE, Engebretsen L, Storheim K, Risberg MA. Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med. 2009;37(7):1434–43.
Funding
This study has received funding by NIH/NIAMS P50 AR060752.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Guimaraes, J.B., Schwaiger, B.J., Gersing, A.S. et al. Meniscal ramp lesions: frequency, natural history, and the effect on knee cartilage over 2 years in subjects with anterior cruciate ligament tears. Skeletal Radiol 50, 551–558 (2021). https://doi.org/10.1007/s00256-020-03596-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-020-03596-5