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Presence of posterior medial tibial plateau edema on MRI linked with ramp lesions
PMTP edema had a sensitivity of 66% for ramp lesions and 44% for meniscal body tears.
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Results presented at the Arthroscopy Association of North America Annual Meeting that were recently published showed the presence of posterior medial tibial plateau edema among patients undergoing ACL reconstruction was associated with significantly greater odds for ramp lesions compared with meniscal body tears.
“We did find that [posterior medial tibial plateau] PMTP edema is a good indicator for the presence of a ramp lesion warranting further exploration of the posterior medial compartment during ACL reconstruction,” Tiahna Spencer, BS, said.
Among 307 patients who underwent ACL reconstruction, 180 patients had meniscal body tears and 127 patients had ramp tears, Spencer noted.
“We found the ramp lesion group tended to be younger, 7.5 years younger, than the meniscal body tear group and that patients who were delayed to ACL reconstruction tended to have a meniscal body tear,” Spencer said.
Among 178 patients with preoperative axial, coronal and sagittal MRIs done with T2 and proton-density sequences available for review, PMTP edema was identified in 54% of patients who underwent ACL reconstruction and had medial meniscal tears. PMTP edema had a sensitivity of 66% and 44% for ramp lesions and meniscal body tears, respectively. However, the presence of PMTP edema had a positive predictive value of 54% for ramp tears, Spencer said.
Patients whose MRI was positive for PMTP edema had a 2.1-times greater odds of having ramp lesions than meniscal body tears.
Cory Edgar, MD, PhD, assistant professor at UConn Health and the study’s lead author, told Orthopedics Today he was surprised there was not a greater correlation of PMTP edema with ramp tears.
“I thought that edema would be highly correlative [to ramp tears] just based on the mechanism of injury that I think is associated with this, but it actually, in a large series, did not correlate as well as I had hoped,” said Edgar, who noted the investigators are now conducting a prospective study to monitor PTMP edema and ramp lesions to determine their clinical importance.
“We are going to try to figure out edema and other things that add up,” Edgar said. The goal, he is said, is to create an algorithm based on MRIs that will help increase the sensitivity and specificity of identifying a ramp lesion. – by Casey Tingle
- References:
- Kumar NS, et al. Orthop J Sports Med. 2018;doi:10.1177/2325967118780089.
- Spencer T, et al. Paper 78. Presented at: Arthroscopy Association of North America Annual Meeting; April 26-28, 2018; Chicago.
- For more information:
- Cory Edgar, MD, PhD, can be reached at One Royce Circle, Suite 104, Storrs, CT 06268; email: coedgar@uchc.edu.
- Tiahna Spencer, BS, can be reached at 263 Farmington Ave., Farmington, CT 06032; email: tspencer@uchc.edu.
Disclosures: Edgar and Spencer report no relevant financial disclosures.
Perspective
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Christopher M. Larson, MD
Medial meniscal ramp lesions are increasingly recognized in the setting of ACL tears. A prior cadaveric study showed the presence of a meniscal ramp lesion (meniscal capsular tear) increased anterior tibial translation and external rotation laxity. This laxity was not completely restored with an isolated ACL reconstruction, but stability was restored with concomitant ACL reconstruction and meniscal ramp repair. Repairing these lesions might better restore knee stability and protect the reconstructed ACL. Limited studies have shown that MRI has a low sensitivity for identifying meniscal ramp lesions. The current study by Kumar and colleagues reported a higher odds ratio (2.1) of having a meniscal ramp lesion identified arthroscopically when posteromedial tibia plateau edema was identified on preoperative MRI in the presence of an ACL tear. The sensitivity for identifying a meniscal ramp lesion on MRI in this study, however, was 66%. Further study is required to better define the utility of MRI for identifying meniscal ramp tears preoperatively. Ultimately, arthroscopic evaluation via a posteromedial portal or Gillquist maneuver with a 70° arthroscope remains the gold standard to best identify the presence of this potentially important meniscal lesion.
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