Even A Moderate Pivot Shift Phenomenon Is A Preoperative Risk Factor For Ramp Lesions In Patients Undergoing Anterior Cruciate Ligament Reconstruction.

Even A Moderate Pivot Shift Phenomenon Is A Preoperative Risk Factor For Ramp Lesions In Patients Undergoing Anterior Cruciate Ligament Reconstruction.

Shoichi Hasegawa, MD, PhD, JAPAN Hideyuki Koga, Prof., MD, PhD, JAPAN Tomomasa Nakamura, MD, PhD, JAPAN Takashi Hoshino, MD, PhD, JAPAN Mai Katakura, MD, PhD, JAPAN Ichiro Sekiya, MD, PhD, JAPAN

Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, JAPAN


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Anatomic Location

Diagnosis / Condition

Patient Populations

Diagnosis Method

Sports Medicine

Treatment / Technique


Summary: Even a moderate pivot shift is a preoperative risk factor for ramp lesions, alongside younger age and male sex.


Background

While prior research has identified various risk factors for ramp lesions, their precise relationship with the severity of the pivot-shift phenomenon remains unclear. This study aimed to clarify this association using the modified International Knee Documentation Committee (IKDC) criteria, known for their rigorous assessment of pivot shift, and to quantify the independent contributions of potential risk factors for ramp lesions.

Methods

We conducted a retrospective analysis of consecutive patients undergoing primary anterior cruciate ligament reconstruction (ACLR) between January 2017 and August 2023. Exclusion criteria included previous ligamentous injuries in the affected knee or concurrent grade 2 or 3 ligament injuries. All patients underwent a standardized preoperative evaluation, including assessment of pivot shift using the modified IKDC grading system. Arthroscopic findings, specifically the presence and characteristics of ramp lesions, were recorded. Statistical analysis included univariate and multivariate logistic regression analyses to identify independent risk factors.

Results

Ramp lesions were identified arthroscopically in 58 out of 262 patients (22.1%). Notably, the presence of ramp lesions was significantly associated with a more pronounced pivot-shift phenomenon. Patients exhibiting a modified IKDC pivot shift grade of 4 or higher were 2.8 times more likely to have ramp lesions compared to those with lower grades (OR: 2.8; 95% CI: [1.520 – 5.110]; p<0.05). Furthermore, younger age (<20 years) and male sex emerged as independent risk factors for ramp lesions, with 2-fold increased odds compared to their respective counterparts.

Discussion

This study highlights the importance of even a moderate degree of pivot shift, as measured by the modified IKDC criteria, as an independent risk factor for ramp lesions. Furthermore, it confirms the increased risk in younger patients and males. These findings advocate for a heightened awareness of ramp lesions, particularly in patients presenting with these risk factors, potentially prompting earlier diagnosis and management. The use of a validated and more sensitive assessment tool for pivot shift strengthens the clinical relevance of our findings, potentially impacting surgical decision-making regarding concomitant ramp lesion treatment during ACLR.