What’s the Diagnosis – Case 145
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What’s the Diagnosis – Case 145
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Findings Classic marrow edema pattern of the lateral compartment is present in keeping with an acute ACL tear. There is also a marrow edema pattern of the posterior medial tibial plateau. There is signal abnormality of the periphery of the posterior horn medial meniscus extending to the meniscocapsular junction.
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Diagnosis: Ramp lesion The entity of meniscal ramp lesion is one that has gained recent, great popularity given new findings in the literature as relates to healing capacity and persistent instability if ramp lesions are not fixed/healed. Adding to this is the difficulty in often seeing these injuries at the time of arthroscopy and awareness to recognize these injuries at the time of preoperative MRI. As such these injuries have gained a lot of traction in the literature but are still extremely poorly defined. Probably at best, ramp lesions are defined as vertically oriented tears often along the longitudinal course of the C shaped meniscus which are present about the periphery of the posterior horn medial meniscus. They are in the vascularized zone and/or within the adjacent meniscocapsular tissue. The meniscocapsular tissue is broken up by some authors into a more complex architecture with a so called superior meniscocapsular ligament and a more inferior meniscotibial ligament. These injuries are often heralded by the edema pattern of the posterior medial tibia as seen in this case. Whether the ramp injury is a contrecoup impaction or avulsion injury is yet to be determined. Additionally, further data is likely to come out arguing for or against greater or less need to repair these injuries. At this time it is probably most important to be aware of these injuries at the time of ACL disruption so at the time of arthroscopy they can be adequately visualized and probed to help render an opinion if they need to be repaired or not.
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