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Objectives: While medial meniscocapsular tears (ramp lesions) are commonly associated with isolated anterior cruciate ligament (ACL) injuries, there are limited descriptions of these meniscal injuries in multi-ligament knee injuries (MLKIs). The purposes of this study were: (1) To retrospectively evaluate preoperative MRIs for the presence of ramp lesions in patients surgically treated for acute grade III combined posterolateral corner knee injuries and (2) To determine if a preoperative posteromedial tibia plateau (PMTP) bone bruise is associated with the presence of preoperative ramp lesions on MRI in these same patients. Methods: Data on consecutive patients at a Level I trauma center with MLKIs between 2001 and 2021 were retrospectively reviewed. Only patients with acute grade III combined PLC injuries who received a magnetic resonance imaging (MRI) scan within 30 days of injury were assessed. Two musculoskeletal radiologists retrospectively reviewed each patient's preoperative MRI for evidence of ramp lesions and bone bruises (Figure 1). Intra-class correlation coefficients (ICCs) were used to calculate reliability among the reviewers. Multivariate analysis was used to evaluate the relationship between bone bruising patterns and the presence of a ramp lesion on MRI. Results: Sixty-eight patients (79.4% male; mean age, 36.2 ± 13.7 years) with an acute grade III combined PLC injury were included in the study (Table 1). On MRI, the ICC for detection of ramp lesions and PMTP bone bruising were 0.921 and 0.938, respectively. Medial meniscal ramp lesions were diagnosed in 18/68 (26.5%). 11/18 (61.1%) patients with ramp lesions also showed evidence of PMTP bruising, while 13/50 (26.0%) patients without ramp lesions had PMTP bruising (P=0.008) (Table 2). When controlling for age and sex, PTMP bruising was significantly associated with the presence of a ramp lesion in combined PLC injuries (OR, 4.62; P=0.012) (Table 3). Conclusions: Preoperative medial meniscal ramp lesions were diagnosed on MRI in 26.5% of patients with acute grade III combined PLC injuries. In addition, PMTP bone bruising was significantly associated with the presence of a ramp lesion in patients with a grade III combined PLC injury. These findings demonstrate the need to assess for potential ramp lesions at the time of multi-ligament reconstruction. [ABSTRACT FROM AUTHOR]

Objectives: Ramp lesions are commonly associated with ACL tears and recent studies have identified these lesions in 17-42% of patients undergoing treatment with ACL reconstruction. In addition to its association with ACL tears, there is increasing recognition that ramp lesions lead to significant biomechanical changes in the knee. Our study seeks to investigate whether patients with type 4 ramp lesions at the time of initial ACL reconstruction have higher rates of reoperation, specifically revision ACL-R, compared to those that undergo ACL-R without a ramp lesion. Methods: Retrospective chart review was conducted on all patients surgically treated with ACL reconstruction at level I academic center from January 2015 to December 2019. Type 4 ramp lesions were diagnosed on preoperative MRIs by two MSK-trained radiologists blinded to clinical information. Demographic, associated injuries, intra-operative, clinical data, and re-operations were extracted from our ACL-R database. Statistical analysis using Students T-test and chi x2 for comparing cohorts. Cox Regression with covariates for re-operation surgery was used. Risk factors evaluated for revision surgery included patient age, sex, BMI, treatment of ramp, timing to surgery. Inter-reliability coefficient correlation was used for MRI reliability. Results: A total of 255 patients ACL-R were identified that met inclusion. There were 170 patients with ACL-R without a ramp present and 85 patients with ACL-R + type 4 ramp lesion. Revision ACL-R occurred in 10.5% in ramp group compared to 2.4% without ramp (P<0.005). Around 75% of the revision ACL-R for the ramp group occurred within the first 2 and half years after surgery. Risk factor associated with revision ACL-R included untreated ramp (HR 10.46 (CI: 2.13-109.70) p=0.01). Conclusions: Meniscal ramp lesions with ACL-R result in higher revision ACL-R when compared to no ramp ACL-R. Most significantly untreated type 4 ramp lesions with concomitant ACL-R were associated with increased risk of ACL-R revision surgery . Standard portals are not sufficient in diagnosing and assessing stability of ramp lesions intra-operatively. [ABSTRACT FROM AUTHOR]

Objectives: Multi-ligamentous knee injuries (MLKIs) are typically caused by high-energy mechanisms that warrant complex clinical decision-making and operative management to achieve optimal outcomes for patients. There is limited literature regarding these rare presentations, with even less information examining the clinical outcomes with respect to the age at which the injury was sustained. The purpose of this study is to investigate clinical outcomes following surgical treatment of MLKIs in patients who were at least 40-years-old at the time of their injury. Methods: The study design was a multi-center retrospective cohort study. Forty-four patients who underwent surgical repair for MLKI from May 2013 to August 2021 and were at least 40-years-old at the time of their injury were identified from two separate institutions. Patients-reported outcomes assessed included International Knee Documentation Committee Subjective Knee (IKDC) Subjective Knee Form, the Lysholm Knee Score, the Tegner Activity Scale (TAS), return-to-sport and return-to-work surveys, and Visual Analogue Scale (VAS) for pain and satisfaction. A multiple regression model was used to quantify the impact of various factors related to the initial injury, including age, sex, BMI, time of follow-up, history of dislocation with injury, and mechanism of injury on the assessed outcome measures. Results: The mean age of the cohort was 48.1 ± 7.0 years old. The mean overall follow-up was 60.8 months ± 36.3 (range 12-167)]. This cohort reported the following: mean IKDC of 63.4 ± 23.5, mean Lysholm score of 72.6 ± 23.6, and mean Tegner scores of 6.3 ± 2.2 before injury and 4.0 ± 2.0 at the time surveyed. These scores align similarly to the literature, indicating mediocre daily functional status. There were 18 patients that reported engagement in sports, with only 5 returning at a mean of 55.5 (± 26.2) weeks. The multiple linear regression model found dislocation to have a coefficient of -22.17 in relation to IKDC (p = 0.009), indicating that prior dislocation would predict a significant functional detriment as measured by the IKDC. A similar regression model with the Lysholm score as the outcome variable found dislocation to have a coefficient of -19.18 (p=.053), approaching significance. None of the other included variables were found to be significantly predicative of poorer outcome measures (p > 0.05), including age. Conclusions: These results demonstrate that age may not be a significant factor to consider with respect to operative management in patients over 40 years old. Instead, dislocation status was found to be a much more significant predictor of clinical outcomes following operative management of MLKIs. Further research should be directed toward understanding which predisposing factors affect the long-term outcomes of MLKI injuries, given the often random nature of their presentation. [ABSTRACT FROM AUTHOR]