MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation
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REVIEW ARTICLE
MRI appearance of the different meniscal ramp lesion types, with clinical and arthroscopic correlation Dylan N. Greif 1 & Michael G. Baraga 1,2 & Michael G. Rizzo 2 & Neil V. Mohile 2 & Flavio D. Silva 4 & Terry Fox 3 & Jean Jose 1,2,3 Received: 24 December 2019 / Revised: 17 January 2020 / Accepted: 21 January 2020 # ISS 2020
Abstract Background Meniscal ramp lesions have been defined as longitudinal vertical peripheral tears of the medial meniscus involving the posterior meniscocapsular ligament, meniscotibial ligament, and/or the red-red zone of the posterior horn. They are heavily associated with anterior cruciate ligament injuries, and because of their potentially important biomechanical role in knee stabilization, injuries to this region may require surgical repair. However, due to their location and lack of general knowledge regarding their different types and associated appearances on magnetic resonance imaging, ramp lesions are routinely underreported. This is compounded by the fact that ramp lesions are also often overlooked during conventional anterior portal arthroscopy when direct visualization is not achieved. Purpose To demonstrate MRI appearances and arthroscopic findings of the different types of meniscal ramp lesions, in the hopes of improving their detection on pre-operative imaging. Keywords Medial meniscus . Posterior horn . Ramp lesions . Meniscocapsular ligament . Meniscotibial ligament
Introduction Meniscal tears have a significant concomitant prevalence in patients with anterior cruciate ligament (ACL) injury, with reported rates of occurrence as high as 79% [1, 2]. Ramp lesions, whose name reflects the ramp-like appearance of the posteromedial zone, are a particular type of injury within the posterior horn of the medial meniscus and its meniscocapsular attachments [3]. Although first described decades ago, there continues to be a lack of an established definition which contributes to its decreased diagnosis [3–5].
* Dylan N. Greif [email protected] 1
University of Miami Sports Medicine Institute, 5555 Ponce de Leon Blvd, Coral Gables, FL 33146, USA
2
Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
3
Department of Radiology, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
4
Department of Radiology, Grupo Osteomuscular, Fleury Medicina e Saúde, São Paulo, Brazil
The most commonly cited definition is that of a peripheral vertical longitudinal detachment of the posterior horn of the medial meniscus due to meniscocapsular ligament tears no greater than 2.5 cm in medio-lateral length, leading to meniscocapsular or meniscotibial separation with a concomitant ACL injury [4, 6]. However, a recent cadaveric study by DePhillipo et al. suggested that 2.0 cm in mediolateral length is the maximum length, given that the width of the posteromedial meniscocapsular junction was only 2 cm in their study cohort [7]. Though some studies have attempted to determine the minimum length of a ramp lesion based on necessity
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