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Over One-Third of Patients with Multi-Ligament Knee Injuries and An Intact Anterior Cruciate Ligament Demonstrate Medial Meniscal Ramp Lesions on Magnetic Resonance Imaging

November 21, 2022

Figure 1

Coronal proton density MR image with distinct femoral and tibial zones used to record the location of the lesions in the coronal plane. Legend: M = medial, C = central, N = notch, MT = medial trochlea, LT = lateral trochlea, L = lateral, MSs = medial sub-spine, and LSs = lateral sub-spine. *The white circle marks the two zones (M) and (C) for posteromedial tibial plateau bruising in the coronal plane in A. Sagittal proton density MR image of the medial tibial plateau with three zones: anterior (A), central (C), and posterior (P) for localization. *The white circle in Fig B marks the sagittal posterior (P) zone for posteromedial tibial plateau bruising.

Journal: The Journal of Arthroscopic and Related Surgery

Who: Jay Moran, B.S., Christopher A. Schneble, M.D., Lee D. Katz, M.D., Andrew E. Jimenez, M.D., William M. McLaughlin, M.D., Kinjal Vasavada, B.S., Annie Wang, M.D., Kyle N. Kunze, M.D., Jorge Chahla, MD, Ph.D., Robert F. LaPrade, M.D., Ph.D., Michael J. Alaia, M.D., Michael J. Medvecky, M.D.

Overview: The objective of this study was to determine the incidence of ramp lesions and posteromedial tibial plateau (PMTP) bone bruising on magnetic resonance imaging (MRI) in patients with multiligament knee injuries (MLKIs) and an intact anterior cruciate ligament (ACL).

A retrospective review of consecutive patients surgically treated for MLKIs at two level I trauma centers between January 2001-March 2021 was performed. Only MLKIs with an intact ACL that received MRI scans within 90 days of the injury were included. All MLKIs were diagnosed on magnetic resonance imaging (MRI) and confirmed with operative reports. Two musculoskeletal radiologists retrospectively re-reviewed pre-operative MRIs for evidence of medial meniscus ramp lesions (MMRLs) and PMTP bone bruises using previously established classification systems. Intra-class correlation coefficients (ICCs) were used to calculate the reliability between the radiologists. The incidence of MMRLs and PMTP bone bruises were quantified using descriptive statistics.

A total of 221 MLKIs were identified, of which 32 (14.5%) had an intact ACL (87.5% male; mean age of 29.9±8.6 years) and were included. The most common MLKI pattern was combined injury to the posterior cruciate ligament (PCL) and posterolateral corner (PLC; N=27, 84.4%). PMTP bone bruises were observed in 12/32 (37.5%) patients. Similarly, MMRLs were diagnosed in 12/32 (37.5%) patients. A total of 8/12 (66.7%) patients with MMRLs demonstrated evidence PMTP bone bruising.

Over one-third of MLKI patients with an intact ACL were diagnosed with MMRLs on MRI in this series. PMTP bone bruising was observed in 66.7% of patients with MMRLs, suggesting that increased vigilance for identifying MMRLs at the time of ligament reconstruction should be practiced in patients with this bone bruising pattern.

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