Analysis of Risk Factors for Ramp Lesions Associated With Anterior Cruciate Ligament Injury
Background: The incidence of meniscocapsular junction tears of the medial meniscus posterior horn, known as ramp lesions, is reported to be 9.3% to 23.9%. However, these lesions are not consistently diagnosed with routine arthroscopic exploration and magnetic resonance imaging (MRI). Purpose: To det...
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| Veröffentlicht in: | The American journal of sports medicine 2020-06, Vol.48 (7), p.1673-1681, Article 0363546520918207 |
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| creator | Kim, Seong Hwan Seo, Hyun Je Seo, Dong Won Kim, Kang-Il Lee, Sang Hak |
| description | Background:
The incidence of meniscocapsular junction tears of the medial meniscus posterior horn, known as ramp lesions, is reported to be 9.3% to 23.9%. However, these lesions are not consistently diagnosed with routine arthroscopic exploration and magnetic resonance imaging (MRI).
Purpose:
To determine risk factors associated with ramp lesions in anterior cruciate ligament–injured knees.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
A total of 275 patients undergoing anterior cruciate ligament reconstruction between June 2011 and March 2019 were included in this study. Exclusion criteria were revisions, fracture histories, and multiple-ligament injuries other than medial collateral ligament injury. Patients were divided into 2 groups, those with and without ramp lesions according to arthroscopic diagnosis. Binary logistic regression was used to analyze risk factors: age, sex, body mass index, time from injury to surgery (3° (OR, 2.339; 95% CI, 1.048-5.217; P = .038), steeper medial tibial slope (OR, 1.289; 95% CI, 1.002-1.66; P = .049) and meniscal slope (OR, 1.464; 95% CI, 1.137-1.884; P = .003), and gradual lateral tibial slope (OR, 0.775; 95% CI, 0.657-0.914; P = .002). The area under the curve for the prediction model developed by logistic regression was 0.779 (sensitivity, 75.8%; specificity, 71.7%; P < .001) for ramp lesions.
Conclusion:
Care should be taken with patients who have significant risk factors for ramp lesions, including bone contusion at the posterior medial tibial plateau, chronic injury, steeper medial tibial and meniscal slope, gradual lateral tibial slope, and varus knee >3°. |
| doi_str_mv | 10.1177/0363546520918207 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_sage_</sourceid><recordid>TN_cdi_sage_journals_10_1177_0363546520918207</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0363546520918207</sage_id><sourcerecordid>2400548424</sourcerecordid><originalsourceid>FETCH-LOGICAL-c365t-ad4a7c22e2165b44d50427641f19b6997d279e26c4725d4405960da0abdeb27c3</originalsourceid><addsrcrecordid>eNqN0c9rFDEUB_Agil2rd08S8CLIaH5n5rgMVgsLQlE8eBgymTc1685kzctQ9r83260VCoKnQPJ5j5fvI-QlZ-84t_Y9k0ZqZbRgDa8Fs4_IimstKimNfkxWx-fq-H5GniFuGWPcmvopOZNC1rIxekW-r2e3O2BAGkd6FfAnvXA-x4R0jIleuWlPN4AhzkjXiNEHl2Gg30L-QddzhhSKatNye0834dpNMGd6OW-XdHhOnoxuh_Di7jwnXy8-fGk_VZvPHy_b9abyZcxcuUE564UAwY3ulRo0U8IaxUfe9KZp7CBsA8J4ZYUelGK6MWxwzPUD9MJ6eU7enPruU_y1AOZuCuhht3MzxAU7oRjTqlZCFfr6Ad3GJZUIblVTK1tYUeykfIqICcZun8Lk0qHjrDsG3z0MvpS8umu89BMM9wV_ki6gPoEb6OOIPsDs4Z6V1WhZnC2jli21IbtcQm_jMudS-vb_S4uuThrdNfz93j8n_w3Phqk9</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2409847842</pqid></control><display><type>article</type><title>Analysis of Risk Factors for Ramp Lesions Associated With Anterior Cruciate Ligament Injury</title><source>Access via SAGE</source><source>Web of Science - Science Citation Index Expanded - 2020<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /></source><source>Alma/SFX Local Collection</source><creator>Kim, Seong Hwan ; Seo, Hyun Je ; Seo, Dong Won ; Kim, Kang-Il ; Lee, Sang Hak</creator><creatorcontrib>Kim, Seong Hwan ; Seo, Hyun Je ; Seo, Dong Won ; Kim, Kang-Il ; Lee, Sang Hak</creatorcontrib><description>Background:
The incidence of meniscocapsular junction tears of the medial meniscus posterior horn, known as ramp lesions, is reported to be 9.3% to 23.9%. However, these lesions are not consistently diagnosed with routine arthroscopic exploration and magnetic resonance imaging (MRI).
Purpose:
To determine risk factors associated with ramp lesions in anterior cruciate ligament–injured knees.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
A total of 275 patients undergoing anterior cruciate ligament reconstruction between June 2011 and March 2019 were included in this study. Exclusion criteria were revisions, fracture histories, and multiple-ligament injuries other than medial collateral ligament injury. Patients were divided into 2 groups, those with and without ramp lesions according to arthroscopic diagnosis. Binary logistic regression was used to analyze risk factors: age, sex, body mass index, time from injury to surgery (<3 or ≥3 months), mechanism of injury (contact/noncontact), Segond fracture, side-to-side laxity, location of bone contusion, medial and lateral tibial/meniscal slope, and mechanical axis angle. Receiver operating characteristic curves and area under the curve were evaluated. A prediction model was developed by multivariable regression with generalized estimating equations.
Results:
Overall, 95 patients (34.5%) were confirmed as having a ramp lesion. The sensitivity of MRI for ramp lesions was 85.3%, and specificity was 78.3%. Significant risk factors for ramp lesion were as follows: posterior medial tibial plateau bone contusion on MRI (odds ratio [OR], 4.201; 95% CI, 2.081-8.482; P < .001), ≥3 months from injury (OR, 4.818; 95% CI, 2.158-10.757; P < .001), varus knee >3° (OR, 2.339; 95% CI, 1.048-5.217; P = .038), steeper medial tibial slope (OR, 1.289; 95% CI, 1.002-1.66; P = .049) and meniscal slope (OR, 1.464; 95% CI, 1.137-1.884; P = .003), and gradual lateral tibial slope (OR, 0.775; 95% CI, 0.657-0.914; P = .002). The area under the curve for the prediction model developed by logistic regression was 0.779 (sensitivity, 75.8%; specificity, 71.7%; P < .001) for ramp lesions.
Conclusion:
Care should be taken with patients who have significant risk factors for ramp lesions, including bone contusion at the posterior medial tibial plateau, chronic injury, steeper medial tibial and meniscal slope, gradual lateral tibial slope, and varus knee >3°.</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/0363546520918207</identifier><identifier>PMID: 32383965</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Contusions ; Fractures ; Joint and ligament injuries ; Knee ; Life Sciences & Biomedicine ; Magnetic resonance imaging ; Orthopedics ; Risk factors ; Science & Technology ; Sport Sciences ; Sports medicine</subject><ispartof>The American journal of sports medicine, 2020-06, Vol.48 (7), p.1673-1681, Article 0363546520918207</ispartof><rights>2020 The Author(s)</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>62</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000533967400001</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c365t-ad4a7c22e2165b44d50427641f19b6997d279e26c4725d4405960da0abdeb27c3</citedby><cites>FETCH-LOGICAL-c365t-ad4a7c22e2165b44d50427641f19b6997d279e26c4725d4405960da0abdeb27c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0363546520918207$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0363546520918207$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>315,782,786,21826,27931,27932,28255,43628,43629</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32383965$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Seong Hwan</creatorcontrib><creatorcontrib>Seo, Hyun Je</creatorcontrib><creatorcontrib>Seo, Dong Won</creatorcontrib><creatorcontrib>Kim, Kang-Il</creatorcontrib><creatorcontrib>Lee, Sang Hak</creatorcontrib><title>Analysis of Risk Factors for Ramp Lesions Associated With Anterior Cruciate Ligament Injury</title><title>The American journal of sports medicine</title><addtitle>AM J SPORT MED</addtitle><addtitle>Am J Sports Med</addtitle><description>Background:
The incidence of meniscocapsular junction tears of the medial meniscus posterior horn, known as ramp lesions, is reported to be 9.3% to 23.9%. However, these lesions are not consistently diagnosed with routine arthroscopic exploration and magnetic resonance imaging (MRI).
Purpose:
To determine risk factors associated with ramp lesions in anterior cruciate ligament–injured knees.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
A total of 275 patients undergoing anterior cruciate ligament reconstruction between June 2011 and March 2019 were included in this study. Exclusion criteria were revisions, fracture histories, and multiple-ligament injuries other than medial collateral ligament injury. Patients were divided into 2 groups, those with and without ramp lesions according to arthroscopic diagnosis. Binary logistic regression was used to analyze risk factors: age, sex, body mass index, time from injury to surgery (<3 or ≥3 months), mechanism of injury (contact/noncontact), Segond fracture, side-to-side laxity, location of bone contusion, medial and lateral tibial/meniscal slope, and mechanical axis angle. Receiver operating characteristic curves and area under the curve were evaluated. A prediction model was developed by multivariable regression with generalized estimating equations.
Results:
Overall, 95 patients (34.5%) were confirmed as having a ramp lesion. The sensitivity of MRI for ramp lesions was 85.3%, and specificity was 78.3%. Significant risk factors for ramp lesion were as follows: posterior medial tibial plateau bone contusion on MRI (odds ratio [OR], 4.201; 95% CI, 2.081-8.482; P < .001), ≥3 months from injury (OR, 4.818; 95% CI, 2.158-10.757; P < .001), varus knee >3° (OR, 2.339; 95% CI, 1.048-5.217; P = .038), steeper medial tibial slope (OR, 1.289; 95% CI, 1.002-1.66; P = .049) and meniscal slope (OR, 1.464; 95% CI, 1.137-1.884; P = .003), and gradual lateral tibial slope (OR, 0.775; 95% CI, 0.657-0.914; P = .002). The area under the curve for the prediction model developed by logistic regression was 0.779 (sensitivity, 75.8%; specificity, 71.7%; P < .001) for ramp lesions.
Conclusion:
Care should be taken with patients who have significant risk factors for ramp lesions, including bone contusion at the posterior medial tibial plateau, chronic injury, steeper medial tibial and meniscal slope, gradual lateral tibial slope, and varus knee >3°.</description><subject>Contusions</subject><subject>Fractures</subject><subject>Joint and ligament injuries</subject><subject>Knee</subject><subject>Life Sciences & Biomedicine</subject><subject>Magnetic resonance imaging</subject><subject>Orthopedics</subject><subject>Risk factors</subject><subject>Science & Technology</subject><subject>Sport Sciences</subject><subject>Sports medicine</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><recordid>eNqN0c9rFDEUB_Agil2rd08S8CLIaH5n5rgMVgsLQlE8eBgymTc1685kzctQ9r83260VCoKnQPJ5j5fvI-QlZ-84t_Y9k0ZqZbRgDa8Fs4_IimstKimNfkxWx-fq-H5GniFuGWPcmvopOZNC1rIxekW-r2e3O2BAGkd6FfAnvXA-x4R0jIleuWlPN4AhzkjXiNEHl2Gg30L-QddzhhSKatNye0834dpNMGd6OW-XdHhOnoxuh_Di7jwnXy8-fGk_VZvPHy_b9abyZcxcuUE564UAwY3ulRo0U8IaxUfe9KZp7CBsA8J4ZYUelGK6MWxwzPUD9MJ6eU7enPruU_y1AOZuCuhht3MzxAU7oRjTqlZCFfr6Ad3GJZUIblVTK1tYUeykfIqICcZun8Lk0qHjrDsG3z0MvpS8umu89BMM9wV_ki6gPoEb6OOIPsDs4Z6V1WhZnC2jli21IbtcQm_jMudS-vb_S4uuThrdNfz93j8n_w3Phqk9</recordid><startdate>20200601</startdate><enddate>20200601</enddate><creator>Kim, Seong Hwan</creator><creator>Seo, Hyun Je</creator><creator>Seo, Dong Won</creator><creator>Kim, Kang-Il</creator><creator>Lee, Sang Hak</creator><general>SAGE Publications</general><general>Sage</general><general>Sage Publications Ltd</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20200601</creationdate><title>Analysis of Risk Factors for Ramp Lesions Associated With Anterior Cruciate Ligament Injury</title><author>Kim, Seong Hwan ; Seo, Hyun Je ; Seo, Dong Won ; Kim, Kang-Il ; Lee, Sang Hak</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-ad4a7c22e2165b44d50427641f19b6997d279e26c4725d4405960da0abdeb27c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Contusions</topic><topic>Fractures</topic><topic>Joint and ligament injuries</topic><topic>Knee</topic><topic>Life Sciences & Biomedicine</topic><topic>Magnetic resonance imaging</topic><topic>Orthopedics</topic><topic>Risk factors</topic><topic>Science & Technology</topic><topic>Sport Sciences</topic><topic>Sports medicine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kim, Seong Hwan</creatorcontrib><creatorcontrib>Seo, Hyun Je</creatorcontrib><creatorcontrib>Seo, Dong Won</creatorcontrib><creatorcontrib>Kim, Kang-Il</creatorcontrib><creatorcontrib>Lee, Sang Hak</creatorcontrib><collection>Web of Science - Science Citation Index Expanded - 2020</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Seong Hwan</au><au>Seo, Hyun Je</au><au>Seo, Dong Won</au><au>Kim, Kang-Il</au><au>Lee, Sang Hak</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Analysis of Risk Factors for Ramp Lesions Associated With Anterior Cruciate Ligament Injury</atitle><jtitle>The American journal of sports medicine</jtitle><stitle>AM J SPORT MED</stitle><addtitle>Am J Sports Med</addtitle><date>2020-06-01</date><risdate>2020</risdate><volume>48</volume><issue>7</issue><spage>1673</spage><epage>1681</epage><pages>1673-1681</pages><artnum>0363546520918207</artnum><issn>0363-5465</issn><eissn>1552-3365</eissn><abstract>Background:
The incidence of meniscocapsular junction tears of the medial meniscus posterior horn, known as ramp lesions, is reported to be 9.3% to 23.9%. However, these lesions are not consistently diagnosed with routine arthroscopic exploration and magnetic resonance imaging (MRI).
Purpose:
To determine risk factors associated with ramp lesions in anterior cruciate ligament–injured knees.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
A total of 275 patients undergoing anterior cruciate ligament reconstruction between June 2011 and March 2019 were included in this study. Exclusion criteria were revisions, fracture histories, and multiple-ligament injuries other than medial collateral ligament injury. Patients were divided into 2 groups, those with and without ramp lesions according to arthroscopic diagnosis. Binary logistic regression was used to analyze risk factors: age, sex, body mass index, time from injury to surgery (<3 or ≥3 months), mechanism of injury (contact/noncontact), Segond fracture, side-to-side laxity, location of bone contusion, medial and lateral tibial/meniscal slope, and mechanical axis angle. Receiver operating characteristic curves and area under the curve were evaluated. A prediction model was developed by multivariable regression with generalized estimating equations.
Results:
Overall, 95 patients (34.5%) were confirmed as having a ramp lesion. The sensitivity of MRI for ramp lesions was 85.3%, and specificity was 78.3%. Significant risk factors for ramp lesion were as follows: posterior medial tibial plateau bone contusion on MRI (odds ratio [OR], 4.201; 95% CI, 2.081-8.482; P < .001), ≥3 months from injury (OR, 4.818; 95% CI, 2.158-10.757; P < .001), varus knee >3° (OR, 2.339; 95% CI, 1.048-5.217; P = .038), steeper medial tibial slope (OR, 1.289; 95% CI, 1.002-1.66; P = .049) and meniscal slope (OR, 1.464; 95% CI, 1.137-1.884; P = .003), and gradual lateral tibial slope (OR, 0.775; 95% CI, 0.657-0.914; P = .002). The area under the curve for the prediction model developed by logistic regression was 0.779 (sensitivity, 75.8%; specificity, 71.7%; P < .001) for ramp lesions.
Conclusion:
Care should be taken with patients who have significant risk factors for ramp lesions, including bone contusion at the posterior medial tibial plateau, chronic injury, steeper medial tibial and meniscal slope, gradual lateral tibial slope, and varus knee >3°.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>32383965</pmid><doi>10.1177/0363546520918207</doi><tpages>9</tpages></addata></record> |
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| subjects | Contusions Fractures Joint and ligament injuries Knee Life Sciences & Biomedicine Magnetic resonance imaging Orthopedics Risk factors Science & Technology Sport Sciences Sports medicine |
| title | Analysis of Risk Factors for Ramp Lesions Associated With Anterior Cruciate Ligament Injury |
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