Balazs George C, Greditzer Harry G, Wang Dean, Marom Niv, Potter Hollis G, Marx Robert G, Rodeo Scott A, Williams Riley J
Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.
Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA.
Orthop J Sports Med. 2019 May 15;7(5):2325967119843509. doi: 10.1177/2325967119843509. eCollection 2019 May.
Ramp lesions are peripheral tears of the posterior horn of the medial meniscus that involve the meniscocapsular attachments or red-red zone and typically occur in conjunction with anterior cruciate ligament (ACL) ruptures.
To identify the prevalence of, and risk factors for, ramp lesions in a large cohort of patients undergoing primary and revision ACL reconstruction.
Case series; Level of evidence, 4.
We queried our institutional registry of patients who underwent primary or revision surgical treatment for an ACL injury. Those who underwent preoperative magnetic resonance imaging (MRI) at our facility were included in the study. Clinical details were extracted and verified using electronic records. All preoperative MRI scans were reviewed by a musculoskeletal radiologist for the presence of a ramp lesion. Stable ramp lesions were defined as a peripheral posterior horn medial meniscal tear identified on MRI but either not identifiable with viewing and probing from the anterior portals or, if identified, not displaceable with anteriorly directed probing. Unstable ramp lesions were defined as peripheral posterior horn medial meniscal tears at the meniscocapsular junction that were identifiable at the time of surgery and displaced into the medial compartment with probing. The prevalence of stable and unstable ramp lesions was calculated. Demographic, injury, and imaging parameters were determined using univariate statistics.
A total of 372 patients were included. The overall prevalence of ramp lesions was 42% (155/372). Unstable ramp lesions were present in 73 (20%) patients, and stable ramp lesions were present in 82 (22%) patients. The presence of any ramp lesion (stable or unstable) was associated with bone marrow edema of the posteromedial tibia on MRI (odds ratio [OR], 3.0; < .0001), a contact injury mechanism (OR, 1.8; = .02), and a concurrent lateral meniscal tear (OR, 1.7; = .02). No demographic, injury, surgical, or radiological variable was associated with a stable versus unstable ramp lesion.
The overall prevalence of a ramp lesion in patients treated for ACL ruptures at our institution was 42%. The presence of bone marrow edema of the posteromedial tibia, a contact injury mechanism, or a lateral meniscal tear should alert surgeons to the potential presence of a medial meniscal ramp lesion.
斜坡损伤是内侧半月板后角的周边撕裂，累及半月板-关节囊附着处或红-红区，通常与前交叉韧带（ACL）断裂同时发生。
确定接受初次和翻修ACL重建的大量患者中斜坡损伤的患病率及危险因素。
病例系列；证据等级，4级。
我们查询了接受ACL损伤初次或翻修手术治疗的患者的机构登记册。在我们机构接受术前磁共振成像（MRI）检查的患者被纳入研究。临床细节通过电子记录提取并核实。所有术前MRI扫描均由肌肉骨骼放射科医生进行检查，以确定是否存在斜坡损伤。稳定斜坡损伤定义为MRI上确定的内侧半月板后角周边撕裂，但从前外侧入路观察和探查时无法识别，或者如果识别到，向前探查时不可移位。不稳定斜坡损伤定义为半月板-关节囊交界处的内侧半月板后角周边撕裂，手术时可识别并在探查时移位至内侧间室。计算稳定和不稳定斜坡损伤的患病率。使用单变量统计确定人口统计学、损伤和影像学参数。
共纳入372例患者。斜坡损伤的总体患病率为42%（155/372）。73例（20%）患者存在不稳定斜坡损伤，82例（22%）患者存在稳定斜坡损伤。任何斜坡损伤（稳定或不稳定）的存在与MRI上胫骨后内侧骨髓水肿相关（比值比[OR]，3.0；P<0.0001）、接触性损伤机制（OR，1.8；P = 0.02）和并发外侧半月板撕裂（OR，1.7；P = 0.02）。没有人口统计学、损伤、手术或放射学变量与稳定或不稳定斜坡损伤相关。
在我们机构接受ACL断裂治疗患者中，斜坡损伤的总体患病率为42%。胫骨后内侧骨髓水肿、接触性损伤机制或外侧半月板撕裂的存在应提醒外科医生注意内侧半月板斜坡损伤的潜在存在。
