Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2025; 35(02): 272-279
DOI: 10.1055/s-0044-1791565
Original Article

Is Trochlear Dysplasia Associated with a High Prevalence of Repaired Anterior Medial Portal Lesions in Anterior Cruciate Ligament-Deficient Knees?

Naveen Kumar
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
,
Pradip Ghimire
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
,
Shrikant Shukla
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
,
Pradeep Kumar Meena
2   Department of Orthopedics, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
,
Sudhir Saxena
3   Department of Radiology, Graphic Era Institute of Medical Sciences, Dehradun, Uttarakhand, India
,
Sonal Saran 
1   Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction Meniscal tears, especially in the medial meniscus, are common in anterior cruciate ligament (ACL) injuries. Repaired anterior medial portal (RAMP) lesions, specific meniscal injuries associated with ACL ruptures, affect the peripheral attachment of the posterior horn of the medial meniscus. While the relationship between femoral trochlear morphology and ACL tears is established, its association with RAMP lesions remains unexplored. This study investigates the association between femoral trochlear morphology and RAMP lesions in ACL-deficient knees using magnetic resonance imaging (MRI) and evaluates MRI's accuracy against arthroscopy.

Materials and Methods This hospital-based, cross-sectional observational study was conducted in a tertiary care center over 18 months. It included 126 adult patients who underwent arthroscopic ACL reconstruction and had preoperative MRI. Variables included age, gender, body mass index, trauma nature, and various MRI parameters, including femoral trochlear morphology and presence of RAMP lesions. MRI findings were compared to arthroscopic findings to evaluate diagnostic accuracy.

Results RAMP lesions were detected in 21 participants (16.7%) via MRI and 28 participants (22.2%) via arthroscopy. MRI showed 71.4% sensitivity and 99.0% specificity for detecting RAMP lesions. No significant association was found between femoral trochlear morphology and RAMP lesions. However, medial tibial slope (TS) and posterior medial tibial bone edema (PMTBE) were significantly associated with RAMP lesions. The agreement between MRI and arthroscopy was high (Cohen's kappa = 0.773, p < 0.001).

Conclusion This study found no significant association between femoral trochlear morphology and RAMP lesions in ACL-deficient knees. Instead, medial TS and PMTBE were significant predictors. MRI proved to have high specificity but moderate sensitivity compared to arthroscopy.

Keywords

RAMP lesions - ACL deficiency - femoral trochlear morphology - medial tibial slope - MRI - arthroscopy

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


Patients' Consent

Informed consent was obtained from all individual participants included in the study.




Publication History

Article published online:
07 October 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Fischer W. Update Meniskus. [Meniscus update] Radiologie (Heidelb) 2024; 64 (04) 254-260
    CrossrefPubMedSearch in Google Scholar
  • 2 Strobel MJ. Menisci. In: Fett HM, Flechtner P. eds. Manual of Arthroscopic Surgery. New York: Springer; 1988: 171-178
    Search in Google Scholar
  • 3 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 (04) e871-e875
    CrossrefPubMedSearch in Google Scholar
  • 4 Greif DN, Baraga MG, Rizzo MG. et al. MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation. Skeletal Radiol 2020; 49 (05) 677-689
    CrossrefPubMedSearch in Google Scholar
  • 5 Tomsan H, Gorbachova T, Fritz RC. et al. Knee MRI: meniscus roots, ramps, repairs, and repercussions. Radiographics 2023; 43 (07) e220208
    CrossrefPubMedSearch in Google Scholar
  • 6 Mostafa Zaky Abdelrazek BH, Waly MR, Abdel Aziz MA, Abdel Aziz A. Different techniques for the management of meniscal ramp lesions using standard anterior portals. Arthrosc Tech 2019; 9 (01) e39-e44
    CrossrefPubMedSearch in Google Scholar
  • 7 Cristiani R, van de Bunt F, Kvist J, Stålman A. High prevalence of meniscal ramp lesions in anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 2023; 31 (01) 316-324
    CrossrefPubMedSearch in Google Scholar
  • 8 Yasuma S, Kobayashi M, Kawanishi Y. et al. Diagnosis of medial meniscal ramp lesion is difficult by pre-operative magnetic resonance imaging evaluation and needs a methodical arthroscopic exploration. J Orthop Sci 2022; 27 (06) 1271-1277
    CrossrefPubMedSearch in Google Scholar
  • 9 Kinugasa T, Mutsuzaki H, Taniguchi Y, Sato Y, Watanabe A, Ikeda K. Utility of axial magnetic resonance images for detecting meniscal ramp lesions associated with anterior cruciate ligament injuries. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 30: 32-35
    PubMedSearch in Google Scholar
  • 10 Brophy RH, Steinmetz RG, Smith MV, Matava MJ. Meniscal ramp lesions: anatomy, epidemiology, diagnosis, and treatment. J Am Acad Orthop Surg 2022; 30 (06) 255-262
    PubMedSearch in Google Scholar
  • 11 Beel W, Mouton C, Tradati D, Nührenbörger C, Seil R. 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 2022; 30 (01) 184-191
    CrossrefPubMedSearch in Google Scholar
  • 12 Kunze KN, Wright-Chisem J, Polce EM, DePhillipo NN, LaPrade RF, Chahla J. Risk factors for ramp lesions of the medial meniscus: a systematic review and meta-analysis. Am J Sports Med 2021; 49 (13) 3749-3757
    CrossrefPubMedSearch in Google Scholar
  • 13 Kim SH, Lee SH, Kim KI, 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 (05) 1582-1589
    CrossrefPubMedSearch in Google Scholar
  • 14 Akgün AS, Agirman M. Associations between anterior cruciate ligament injuries and patella alta and trochlear dysplasia in adults using magnetic resonance imaging. J Knee Surg 2021; 34 (11) 1220-1226
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Ntagiopoulos PG, Bonin N, Sonnery-Cottet B, Badet R, Dejour D. The incidence of trochlear dysplasia in anterior cruciate ligament tears. Int Orthop 2014; 38 (06) 1269-1275
    CrossrefPubMedSearch in Google Scholar
  • 16 Botchu R, Obaid H, Rennie WJ. Correlation between trochlear dysplasia and anterior cruciate ligament injury. J Orthop Surg (Hong Kong) 2013; 21 (02) 185-188
    CrossrefPubMedSearch in Google Scholar
  • 17 Isıklar S, Ozdemir ST, Gokalp G. An association between femoral trochlear morphology and non-contact anterior cruciate ligament total rupture: a retrospective MRI study. Skeletal Radiol 2021; 50 (07) 1441-1454
    CrossrefPubMedSearch in Google Scholar
  • 18 Song GY, Liu X, Zhang H. et al. Increased medial meniscal slope is associated with greater risk of ramp lesion in noncontact anterior cruciate ligament injury. Am J Sports Med 2016; 44 (08) 2039-2046
    CrossrefPubMedSearch in Google Scholar
  • 19 Elias DA, White LM. Imaging of patellofemoral disorders. Clin Radiol 2004; 59 (07) 543-557
    CrossrefPubMedSearch in Google Scholar
  • 20 Tang Z, Luo Y, Liu D. et al. Investigation of the anatomic risk factors in acute anterior cruciate ligament ruptures to develop ramp lesions of the medial meniscus by quantitative MRI. Insights Imaging 2024; 15 (01) 133
    CrossrefPubMedSearch in Google Scholar
  • 21 D'Ambrosi R, Sconfienza LM, Albano D. et al. High incidence of RAMP lesions and a nonnegligible incidence of anterolateral ligament and posterior oblique ligament rupture in acute ACL injury. Knee Surg Sports Traumatol Arthrosc 2024; 32 (08) 1992-2002
    CrossrefPubMedSearch in Google Scholar
  • 22 Jiang J, Liu Z, Wang X, Xia Y, Wu M. Increased posterior tibial slope and meniscal slope could be risk factors for meniscal injuries: a systematic review. Arthroscopy 2022; 38 (07) 2331-2341
    CrossrefPubMedSearch in Google Scholar
  • 23 Mahmood A, Mlv SK, Garika SS, Mittal R, Digge VK, Gamanagatti S. Ramp lesions in chronic anterior cruciate ligament injuries. Cureus 2022; 14 (08) e28450
    PubMedSearch in Google Scholar
  • 24 Familiari F, Tollefson LV, Izzo A, Mercurio M, LaPrade RF, Di Vico G. A high-grade Lachman's exam predicts a ramp tear of the medial meniscus in patients with anterior cruciate ligament tear: a prospective clinical and radiological evaluation. J Clin Med 2024; 13 (03) 683
    CrossrefPubMedSearch in Google Scholar
  • 25 Green JS, Moran J, Marcel A. et al. Posteromedial tibial plateau bone bruises are associated with medial meniscal ramp lesions in patients with concomitant anterior cruciate ligament ruptures: a systematic review & meta-analysis. Phys Sportsmed 2023; 51 (06) 531-538
    CrossrefPubMedSearch in Google Scholar
  • 26 Moteshakereh SM, Zarei H, Nosratpour M. et al. Evaluating the diagnostic performance of MRI for identification of meniscal ramp lesions in ACL-deficient knees: a systematic review and meta-analysis. J Bone Joint Surg Am 2024; 106 (12) 1117-1127
    CrossrefPubMedSearch in Google Scholar
  • 27 D'Ambrosi R, Di Maria F, Ursino C. et al. Magnetic resonance imaging shows low sensitivity but good specificity in detecting ramp lesions in children and adolescents with ACL injury: a systematic review. J ISAKOS 2024; 9 (03) 371-377
    CrossrefPubMedSearch in Google Scholar
  • 28 Laurens M, Cavaignac E, Fayolle H. et al. The accuracy of MRI for the diagnosis of ramp lesions. Skeletal Radiol 2022; 51 (03) 525-533
    CrossrefPubMedSearch in Google Scholar