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. 2021 May 17;10(6):e1539-e1542.
doi: 10.1016/j.eats.2021.02.022. eCollection 2021 Jun.

How to Detect Meniscal Ramp Lesions Using Ultrasound

Junsuke Nakase  1 , Kazuki Asai  1 , Rikuto Yoshimizu  1 , Mitsuhiro Kimura  1 , Hiroyuki Tsuchiya  1
Affiliations

How to Detect Meniscal Ramp Lesions Using Ultrasound

Junsuke Nakase et al. Arthrosc Tech. .

Abstract

The clinical importance of meniscal ramp lesions in patients with anterior cruciate ligament tears has emerged. However, the diagnostic accuracy of magnetic resonance imaging for detecting meniscal ramp lesions is low. The advantage of ultrasonography is that it can be performed in any position and is a real-time imaging modality. The goal of this Technical Note is to describe in detail the ultrasound technique that we use to detect meniscal ramp lesions in patients with anterior cruciate ligament tears. The semimembranosus muscle is a reliable landmark for this technique. The examination position is prone, with the knee joint flexed to 70°. The most important part of this technique is to instruct the patient to perform isometric contractions in knee flexion with the support of an assistant. The presence or absence of a meniscal ramp lesion can be diagnosed preoperatively by setting the probe above the semimembranosus tendon.

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Figures

Fig 1
Fig 1
Patient position. The patient is placed in the prone position with knee flexed to approximately 70° and supported by an assistant.
Fig 2
Fig 2
Short-axis ultrasound image at 1 cm above the knee joint line (A) and joint line (B) semitendinosus tendon overlying the semimembranosus muscle belly (left knee). This results in a “cherry on a pie” appearance (A). On the lateral side of the semimembranosus tendon, the muscle belly of the medial head of gastrocnemius is observed (B).
Fig 3
Fig 3
Long-axis ultrasound image at the knee joint line. The probe is placed at approximately 90° just above the semimembranosus tendon to obtain a long-axis view. Semimembranosus tendon located above the medial meniscus. The patient is instructed to perform isometric contractions in knee flexion with the support of an assistant. If there is a ramp lesion, a low echoic space appears below the semimembranosus tendon and joint capsule. The medial meniscus left behind the contraction of the semimembranosus muscle can be observed. The white arrow indicates the ramp lesion. Left is the relaxed state, and right is the isometric contraction state. (MM, medial meniscus; SM, semimembranosus.)
Fig 4
Fig 4
Arthroscopic findings from posteromedial portal of left knee joint. The black arrow indicates the ramp lesion. (MM, medial meniscus.)
See this image and copyright information in PMC

References

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