Prevalence and Detection of Meniscal Ramp Lesions in Pediatric Anterior Cruciate Ligament–Deficient Knees
| Autor: | Camille Thevenin-Lemoine, Marie Faruch Bilfeld, Julie Vial, Isabelle Bernardini, Franck Accadbled, Daniel N’Dele, Etienne Cavaignac |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Anterior cruciate ligament reconstruction medicine.medical_treatment Anterior cruciate ligament Meniscal tears Physical Therapy Sports Therapy and Rehabilitation Menisci Tibial Cohort Studies Arthroscopy 03 medical and health sciences 0302 clinical medicine Prevalence medicine Humans Orthopedics and Sports Medicine Ramp lesion Anterior Cruciate Ligament Child 030222 orthopedics medicine.diagnostic_test business.industry Anterior Cruciate Ligament Injuries Magnetic resonance imaging 030229 sport sciences Magnetic Resonance Imaging Tibial Meniscus Injuries Surgery medicine.anatomical_structure Tears Female Knee injuries business |
| Zdroj: | The American Journal of Sports Medicine. 49:1822-1826 |
| ISSN: | 1552-3365 0363-5465 |
| Popis: | Background: Anterior cruciate ligament (ACL) tears represent 13% of knee injuries in children. Medial meniscal tears are commonly associated with ACL ruptures. Ramp lesions correspond to posterior meniscocapsular tears of the medial meniscus. Depending on the study, the prevalence of ramp lesions is inconsistent. Purpose: To describe the prevalence of ramp lesions in children and adolescents and to investigate the sensitivity of magnetic resonance imaging (MRI) for diagnosing such lesions. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: We analyzed videos from arthroscopic ACL reconstruction (ACLR) in children. During these procedures, we systematically looked for potential ramp lesions. To do so, an arthroscope was passed through the intercondylar notch to visualize the posteromedial compartment. A needle was introduced at the site of a posteromedial portal to unfold the meniscocapsular junction to reveal any hidden meniscal tear. Surgical procedures were performed by 2 senior surgeons. Videos were blindly analyzed by a third surgeon. Preoperative MRIs were screened by 2 blinded, independent senior radiologists to look specifically for ramp lesions. Results: Videos of 50 consecutive arthroscopic ACLRs concerning 32 boys and 18 girls were analyzed. Mean age at surgery was 14.2 years (range, 8.5-17.6 years). A total of 14 ramp lesions (28%) in 8 boys and 6 girls were identified. In addition, there were 22 tears of the meniscal body in 20 patients (40%). Arthroscopic and MRI findings did not correlate. Among 14 arthroscopically diagnosed ramp lesions, only 8 were detected on the MRI. Conversely, 12 patients had a ramp lesion detected on the MRI, which could not be confirmed intraoperatively. The sensitivity of MRI was 57% and the positive predictive value was 40%. Conclusion: A meniscal ramp lesion was present in 14 of 50 children (28%) undergoing ACLR. MRI has a low sensitivity for diagnosis of ramp lesions in children. Careful exploration of the posteromedial compartment is strongly recommended. Overlooking such lesions during ACLR may contribute to ongoing instability and higher re-rupture rates in these young patients. |
| Databáze: | OpenAIRE |
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