Purpose

The aim of this study is to evaluate whether arthrometric tests can predict with sufficient accuracy the presence of medial meniscus RAMP lesions.

Methods

A cohort of 48 patients with complete ACL tear was retrospectively evaluated, and the prevalence of associated RAMP lesions was determined. A multiple logistic regression was performed to assess which factors (age, time from injury, side-to-side difference in arthrometric tests using KT1000, Lachman and Pivot shift test, Lysholm Tegner and VAS score) can be statistically related to the presence of RAMP lesions. A Receiver Operating Characteristic (ROC) curve analysis was constructed for each factor that was found to be statistically associated, determining the diagnostic performance in terms of sensitivity and specificity.

Results

Ten patients (5 stable tears, 4 unstable tears and 1 “hidden lesion”, 20.8%) had a concomitant RAMP lesion. Logistic regression showed that only arthrometric tests, and specifically the side-to-side difference at KT1000, are statistically associated with RAMP lesions. ROC curve analysis (AUC 0.781, 95% CI 0.590 - 0.992) showed that a side-to-side difference in arthrometric tests > 5.5 can diagnose the presence of RAMP lesion with a sensitivity of 0.75, but a specificity of only 0.56. Indeed, the mean side-to-side difference was greater in patients with RAMP lesions than in patients with isolated ACL tears, but no statistically significant difference was found when compared to patients with ACL tear and combined other meniscal tears.

Conclusion

A side-to-side difference on arthrometric tests > 5.5 should alert the surgeon to the presence of associated meniscal tears, including RAMP lesions of the medial meniscus. However, a proper arthroscopic evaluation of these lesions remains essential in order to reduce the risk of misdiagnosed tears and, therefore, compromise the success of ACL reconstruction.