Diagnostic Accuracy of Sequential Arthroscopic Approach for Ramp Lesions of the Posterior Horn of the Medial Meniscus in Anterior Cruciate Ligament-Deficient Knee

초록

Purpose: To document the diagnostic accuracy and steps for sequential arthroscopic exploration of ramp lesions peripheral tear within 4 mm of meniscocapsular junction of medial meniscus associated with anterior cruciate ligament (ACL) injury. Methods: This was a prospective consecutive study of 195 primary ACL reconstructions with arthroscopic exploration for ramp lesion in 4 steps: (1) standard exploration through the anterolateral portal, (2) through the intercondylar space using a 30 degrees arthroscope, (3) through the intercondylar space using a 70 degrees arthroscope, and (4) after creation of a posteromedial portal. Acute (<3 months) and chronic case (>3 months) groups were compared, and the sensitivity and specificity of magnetic resonance imaging (MRI) were assessed. Results: Overall, 50 patients (26.6%) were confirmed as having a ramp lesion. After step 1, only 19 cases (38%) were identified as a ramp lesion. After step 2, 24 cases (48%) were found, and the sensitivity of step 2 was estimated at 48%. After step 3, an additional 26 cases (52%) were identified. No more additional cases of ramp lesion were found after step 4. There were statistically significant differences between steps 2 and 3 (P =.001), but no differences between steps 1 and 2, or steps 3 and 4. Although there were no statistical differences in overall prevalence for acute (28/128, 21.8%) and chronic (22/67, 32.8%) groups (P =.136), the incidence of ramp lesion confirmed through the standard portal approach was found to be significantly correlated with chronic group (odds ratio: 2.95, P =.023). The sensitivity and specificity of preoperative MRI were 84% and 95.17%. Conclusions: Many ramp lesions could not be diagnosed through the standard portal and intercondylar space using a 30 degrees arthroscope. Posteromedial inspection using a 70 degrees arthroscope has improved the diagnostic accuracy for ramp lesion without direct exploration through the posteromedial portal. Care should be taken to identify ramp lesions when ACL reconstruction is performed.

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