Published online: 22 July 2017
MRI can accurately detect meniscal ramp lesions of the knee.
Arner, JW, et al.
Knee Surg Sports Traumatol Arthrosc. (2017); Mar 25
[Epub ahead of print]; PMID 28343325.
Injuries of the posterior meniscocapsular attachment of
the medial meniscus, i.e. “ramp” lesions, are relatively
common following anterior cruciate ligament (ACL) tear
(9% - 17% incidence). These lesions are considered dif-
ficult to diagnose on MR and challenging to identify at
arthroscopy. This study evaluated the accuracy and repro-
ducibility of MR imaging diagnosis of these lesions. On
MR, a ramp lesion was defined as an irregular fluid sig-
nal line completely traversing the capsular margin of the
posterior horn of the medial meniscus Ninety patients
(mean age 28 years, 45 male) with complete ACL tear
with preoperative knee MR imaging who underwent ar-
throscopy were included in the study. The study group
included consecutive ACL tear patients with ramp lesions
between 2013 and 2015 and an added group of control
patients (ACL tears without ramp lesions) selected to be
large enough to reproduce the expected incidence of
ramp lesions in the total study population. MR images
were retrospectively reviewedinablindedfashiontwice
by 3 independent observers with a 2 month period be-
tween reviews. 13 patients had arthroscopically proven
ramp lesions; the other 77 had other meniscal pathology.
Specificities and negative predictive values of MR for all
readers were very high, 92% - 99% and 91% - 97%,
respectively. Sensitivities and positive predictive values
were lower and showed greater variability amongst
readers, 54% - 85% and 50% - 90%, respectively.
Intraobserver reliability was high, 0.75–0.81, while
interobserver agreement was only moderate, 0.56. The
authors conclude that MR is an excellent way to preop-
eratively exclude ramp injuries; however, since some le-
sions may be missed by MR, arthroscopy remains most
reliable for accurate diagnosis. The clinical importance of
treating ramp lesions remains unknown.
Magnetic resonance imaging predictors of failure in the
nonoperative management of ulnar collateral ligament
injuries in professional baseball pitchers.
Frangiamore SJ, et al.
Am J Sports Med. (2017); 45(8):1783–9
32 professional pitchers with ulnar collateral ligament
(UCL) injuries of the elbow initially treated non-
operatively (surgical reconstruction was performed if ini-
tial therapy failed) with at least one full season of profes-
sional baseball before and after treatment were identified
from the MLB Health and Injury Tracking System. MR
images of these patients were evaluated for UCL injury
location (proximal, middle, distal), grade (partial tear: ab-
normal signal and loss of striation pattern, high grade:
>50% fibers torn to full thickness tear) and evidence of
chronic changes (loss of striation pattern with normal or
low signal and/or cortical thickening, osseous hypertrophy
or chronic avulsion at the ligament insertion). Non-
operative treatment was considered “successful” (the pitch-
er returned to the same level of play) for 66% (21/32) and a
“failure” (pain or weakness recurred on attempted return to
a throwing regimen requiring operative treatment) for the
remaining 11. While physical exam showed no difference
between players with successful and failed non-operative
treatment, the presence of a distal UCL tears was found to
Skeletal Radiol (2017) 46:1461–1462