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- Title
Analysis of Risk Factors for Ramp Lesions Associated With Anterior Cruciate Ligament Injury.
- Authors
Kim, Seong Hwan; Seo, Hyun Je; Seo, Dong Won; Kim, Kang-Il; Lee, Sang Hak
- 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°.
- Subjects
AGE distribution; ANTERIOR cruciate ligament surgery; ANTERIOR cruciate ligament injuries; ARTHROSCOPY; CHI-squared test; CONFIDENCE intervals; GOODNESS-of-fit tests; KNEE; LONGITUDINAL method; MAGNETIC resonance imaging; MENISCUS injuries; HEALTH outcome assessment; RISK assessment; SEX distribution; STATISTICS; T-test (Statistics); LOGISTIC regression analysis; STATISTICAL power analysis; DATA analysis; STATISTICAL significance; BODY mass index; CROSS-sectional method; RETROSPECTIVE studies; RECEIVER operating characteristic curves; DATA analysis software; DESCRIPTIVE statistics; ODDS ratio; MANN Whitney U Test; INTRACLASS correlation; DISEASE complications; DISEASE risk factors
- Publication
American Journal of Sports Medicine, 2020, Vol 48, Issue 7, p1673
- ISSN
0363-5465
- Publication type
Article
- DOI
10.1177/0363546520918207