Diagnostic performance of open MRI in the flexed knee position for the detection of medial meniscus ramp lesions
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SCIENTIFIC ARTICLE
Diagnostic performance of open MRI in the flexed knee position for the detection of medial meniscus ramp lesions Yuki Okazaki 1 & Takayuki Furumatsu 1 & Soichiro Okamoto 2 & Takaaki Hiranaka 1 & Keisuke Kintaka 1 & Shinichi Miyazawa 1 & Toshifumi Ozaki 1 Received: 18 March 2020 / Revised: 17 May 2020 / Accepted: 20 May 2020 # ISS 2020
Abstract Objectives To identify the diagnostic performance of magnetic resonance imaging (MRI) in the knee-flexed position for the detection of meniscal ramp lesions in patients with anterior cruciate ligament tears. Materials and methods Forty-three patients (mean age 24.5 ± 9.5 years; 21 males, 22 females) with an arthroscopically proven anterior cruciate ligament tear were included in this retrospective study. The presence of the following two important features on MRI was recorded: irregularity of the medial meniscus at the posterior margin, and complete fluid filling between the posterior horn of the medial meniscus and the capsule margin. Findings obtained in arthroscopy served as the reference standard. The diagnostic sensitivity, specificity, and inter-observer agreement were calculated. Results Sixteen ramp lesions were noted on arthroscopy (37.2%). With an irregularity of the medial meniscus at the posterior margin on MRI, the sensitivity and specificity were 87.5 and 59.3% at 10° knee flexion and 93.8 and 85.2% at 90° flexion, respectively. The complete fluid filling sign on MRI showed sensitivity and specificity of 31.3 and 100% at 10° knee flexion and 87.5 and 100% at 90° flexion, respectively. The concordance between the two observers for the two MRI features was very good (k = 0.70–0.88). Conclusion MRI with the knee in the flexed position improves the diagnostic performance of the detection of meniscal ramp lesions compared with MRI with the knee in the extended position. Keywords Ramp lesion . Magnetic resonance imaging . Irregularity of the medial meniscus . Complete fluid filling
Introduction A ramp lesion is a disruption in the meniscocapsular attachments of the medial meniscus (MM) posterior horn (PH) and is characterized by a superior meniscocapsular or inferior meniscotibial ligament tear, or both [1–5]. The overall incidence of meniscus ramp lesions in a study involving over 1000 patients was 15.8–23.9% [6, 7], and they are known to Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00256-020-03480-2) contains supplementary material, which is available to authorized users. * Takayuki Furumatsu [email protected] 1
Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
2
Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
occur after traumatic knee injuries, especially anterior cruciate ligament (ACL) tears. The presence of bone marrow edema in the posteromedial tibia, a contact injury mechanism, and increased MM slope are reported risk factors for ramp lesions [2, 7–10]. The
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