Clinical outcomes and reoperation rates of stable and unstable ramp lesions in the setting of ACL rupture
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LETTER TO THE EDITOR
Clinical outcomes and reoperation rates of stable and unstable ramp lesions in the setting of ACL rupture George C. Balazs1 · Harry G. Greditzer IV1 · Dean Wang3 · Niv Marom4 · Hollis G. Potter2 · Scott A. Rodeo4 · Robert G. Marx4 · Riley J. Williams III4 Received: 14 September 2020 / Accepted: 28 September 2020 © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2020
Author response to letter to the editor re: “Non-treatment of stable ramp lesions does not degrade clinical outcomes in the setting of primary ACL reconstruction.” We appreciate the detailed comments by Cerciello et al. regarding our recent article, “Non-treatment of stable ramp lesions does not degrade clinical outcomes in the setting of primary ACL reconstruction” [2]. They express great concern regarding both our method of diagnosis of ramp lesions, as well as our conclusion that stable ramp lesions (lesions which do not displace with probing from the anterior portal) can be safely ignored without worsening clinical results of primary ACL reconstruction. With regards to our method of diagnosis, we agree with Cerciello et al. that MRI has been reported as having highly variable sensitivity and specificity in the literature. They especially emphasize the work of Bollen et al. who found an overall incidence of 9.3% among 183 knees undergoing ACL reconstruction, none of which were visible on MRI [3]. It is worth noting that this paper, published in 2010, provided no information on the MRI sequences and magnet strength Investigation performed at Hospital for Special Surgery, New York, NY. This reply refers to the comment available online at https://doi. org/10.1007/s00167-020-06235-7. * George C. Balazs [email protected] 1
Bone and Joint Sports Medicine Institute, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708, USA
2
Department of Radiology, Hospital for Special Surgery, New York, USA
3
Department of Orthopaedic Surgery, University of California, Irvine, Irvine, USA
4
Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, USA
employed. The more appropriate comparison is likely the work of Arner et al. published in 2017, which found moderate-to-high (54–99%) sensitivity and high (92–99%) specificity of MRI when compared to intraoperative examination using a posteromedial portal [1]. These examinations were performed with a 1.5 T MRI, whereas we utilized a 3.0 T MRI with high in plane and through plane resolution. Imaging technology advances rapidly, and one should be cautious of drawing particularly strong conclusions from imagingbased studies published over a decade ago. Additionally, the prevalence of ramp lesions using our 3.0 T MRI-based methodology was 41%, which is comparable to the prevalence from series using posteromedial examination [4, 9]. If, as is commonly claimed, up to 48% ramp lesions are missed using conventional techniques [4], then the “true” prevalence in our series was
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