RESUMO
The purpose of this review is to describe the anatomy and lesions affecting the peripheral portion of posterior horn of medial menisci (ramp lesions), along with illustrations and MRI cases. We will correlate imaging features with arthroscopic classification of ramp lesions. Also, postoperative and chronic changes related to meniscocapsular tears will be presented, as well as biomechanical consequences and treatment approach.
RESUMO
OBJECTIVE: To describe and evaluate the reproducibility by MRI of an arthroscopically-based classification for meniscal ramp lesions. We hypothesize that MRI would present good interobserver and intraobserver reliability to evaluate meniscal ramp lesions. MATERIALS AND METHODS: Twenty MRI of the knee with arthroscopically-proven meniscal ramp lesions were independently assessed by two skilled musculoskeletal radiologists and a third-year radiology resident. Reading was performed in a randomized and anonymous manner, in two steps, with a minimum of 1-month interval between each. Cohen's kappa coefficient statistic was used to analyze intra and interobserver reading agreement. Associate findings were also categorized. RESULTS: From 20 subjects, 17 were male, with mean age of 35 years. MRI reading showed type IV ramp lesion as most prevalent with eight cases (37%), followed by type V - four (21%), type I - four (20%), type III - three, (16%) and type II - one (6%). Regarding ramp lesion types, intraobserver agreement was substantial for both skilled readers (Kappa = 0.72), and moderate for the less experienced reader (Kappa = 0.51); interobserver agreement was moderate. Results between most experienced readers were also analyzed in two categories: stable (types I and II) and unstable (types III, IV and V), also resulting in moderate agreement (Kappa = 0.54). Intraobserver agreement was substantial for both readers (Kappa = 0.68). The most common associate findings were joint effusion (85%), posteromedial capsular structures injury (60%), and medial meniscus extrusion (60%). CONCLUSION: The arthroscopy classification for meniscal ramp lesions stability adapted for MRI has good reproducibility when applied by trained musculoskeletal radiologists.
Assuntos
Artroscopia/métodos , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Meniscos Tibiais/diagnóstico por imagem , Lesões do Menisco Tibial/diagnóstico , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Lesões do Menisco Tibial/classificação , Adulto JovemRESUMO
Anteriior cruciate ligament injuries are known to be the most common spots injuries, and ACL reconstruction is widely used because of the low success rate of convservative treatment. This study was aimed to compare the short-terma functional results of modifying transtibial and transportal technique for femoral tunnel drilling. This Retrospective comparative case control study included 76 patients with an isolated ACL tear, operated with ST tendon autograft ACL reconstruction by the same surgical tea. 36 patients operated with a modified transtibial approach and 40 patients with an antreomedial approach for femoral drilling. The results of the current study revealed that the mean age in the series was 26 years; the majority of patients were male, only 6 patient's asses again after two years of surgery, by instability tests and lysholm scores reveal no significant differences between two group regarding anterioposterior and rotatory instability, also comparable lysholm score results. The Study concluded that modified transtibial femoral drilling of the femoral tunnel in ACL reconstruction surgery is still useful and give comparable results as tranportal drilling (AU)