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Meta-Analysis
. 2024 Jun 19;106(12):1117-1127.
doi: 10.2106/JBJS.23.00501. Epub 2024 Apr 9.

Evaluating the Diagnostic Performance of MRI for Identification of Meniscal Ramp Lesions in ACL-Deficient Knees: A Systematic Review and Meta-Analysis

Seyed Mohammadmisagh Moteshakereh  1 , Hooshmand Zarei  1 , Miad Nosratpour  1 , Mana Zaker Moshfegh  1 , Proushat Shirvani  2 , Alireza Mirahmadi  1 , Mahyar Mahdavi  1 , Reza Minaei Noshahr  1 , Mehrdad Farrokhi  3 , Seyyed Morteza Kazemi  1
Affiliations
Meta-Analysis

Evaluating the Diagnostic Performance of MRI for Identification of Meniscal Ramp Lesions in ACL-Deficient Knees: A Systematic Review and Meta-Analysis

Seyed Mohammadmisagh Moteshakereh et al. J Bone Joint Surg Am. .

Abstract

Background: Despite vigorous efforts to delineate the efficacy of magnetic resonance imaging (MRI) for the diagnosis of meniscal ramp lesions, there is still a great deal of uncertainty regarding its diagnostic performance. Therefore, we conducted a systematic review and meta-analysis to investigate the diagnostic performance of MRI for detecting ramp lesions in anterior cruciate ligament (ACL)-deficient knees.

Methods: We performed a systematic search of MEDLINE via PubMed, Scopus, Web of Science, and Embase and included all articles, published before October 20, 2022, comparing the accuracy of MRI with that of arthroscopy as the gold standard for diagnosis of ramp lesions. We performed statistical analysis using Stata and Meta-DiSc software. Quality assessment of the included studies was performed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool.

Results: This meta-analysis evaluated 21 diagnostic performance comparisons from 19 original research articles (2,149 patients). The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic (SROC) curve for diagnosing a ramp lesion were 0.70 (95% confidence interval [Cl], 0.66 to 0.73), 0.88 (95% Cl, 0.86 to 0.89), 6.49 (95% Cl, 4.12 to 10.24), 0.36 (95% Cl, 0.28 to 0.46), 24.33 (95% Cl, 12.81 to 46.19), and 0.88, respectively. Meta-regression using different variables yielded the same results.

Conclusions: MRI exhibited a DOR of 24.33 and moderate sensitivity, specificity, and accuracy for diagnosing ramp lesions in ACL-deficient knees. However, arthroscopy using a standard anterolateral portal with intercondylar viewing is recommended to confirm a diagnosis of a ramp lesion.

Level of evidence: Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: This study was internally funded by grant 43004936 from the Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran. SBMU did not participate in the study design, data collection, analysis, or decision to submit the paper. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H965 ).

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