Case Report

A Case Report of a Rare Presentation of Semimembranosus Tibial Plateau Avulsion: The Bony Ramp Lesion

Abstract

Background:Tibial plateau posteromedial rim avulsions by semimembranosus tendon are a rare entity that have been reported in a few studies so far with controversial mechanisms. They are reported to accompany anterior cruciate ligament (ACL) or meniscal injuries. Their main fracture planes are usually placed in the coronal plane.
Case Report: The patient was a 52-year-old man with a hyperextension-valgus tibial plateau fracture. The imaging studies revealed a compression fracture of the lateral and an avulsion fracture of the posteromedial plateau. However, no soft-tissue injuries were detected. The fragment was avulsed in the axial plane and covered by the medial meniscal posterior horn, creating the pattern of a longitudinal tear in the meniscal ramp lesion, but actually without any soft-tissue injuries. It was fixated using the tension band wiring technique with two Kirschner wires (K-wires) and one cancellous screw. Radiological and functional outcomes were excellent at 12-month follow-up.
Conclusion: This fracture pattern merits special attention due to its unusual presentation, causing the meniscal posterior horn to separate from the articular surface. “Bony ramp lesion” best describes the simultaneous separation of the posterior horn of the medial meniscus (PHMM) and its underlying bony fragment without the meniscal tear that takes place in an actual medial meniscal ramp lesion.

1. Moore TM. Fracture--dislocation of the knee. Clin Orthop Relat Res. 1981;(156):128-40. [PubMed: 7226641].
2. Hohl M. Managing the challenge of tibial plateau fractures. J Musculoskel Med. 1991;8(6):70-86.
3. Yao L, Lee JK. Avulsion of the posteromedial tibial plateau by the semimembranosus tendon: diagnosis with MR imaging. Radiology. 1989;172(2):513-4. doi: 10.1148/radiology.172.2.2748833. [PubMed: 2748833].
4. Vanek J. Posteromedial fracture of the tibial plateau is not an avulsion injury. A case report and experimental study. J Bone Joint Surg Br. 1994;76(2):290-2. [PubMed: 8113295].
5. Chan KK, Resnick D, Goodwin D, Seeger LL. Posteromedial tibial plateau injury including avulsion fracture of the semimembranous tendon insertion site: ancillary sign of anterior cruciate ligament tear at MR imaging. Radiology1999;211(3):754-8. doi: 10.1148/radiology.211.3.r99jn16754. [PubMed: 10352602].
6. Al-Humadi M, Fulkerson EW, Egol KA. Semimembranosus tendon mediated avulsion fracture of the posteromedial tibial plateau. J Trauma. 2009;66(1):E1-E3. doi: 10.1097/01.ta.0000242218.33654.2c. [PubMed: 18277293].
7. Khoshnoodi P, Tehranzadeh AD, Dunn JM, Tehranzadeh J. Semimembranosus tendon avulsion fracture of the posteromedial tibial plateau associated with posterior cruciate ligament tear and capsular rupture. Skeletal Radiol. 2014;43(2):239-42. doi: 10.1007/s00256-013-1719-z. [PubMed: 24026070].
8. John R, Chouhan DK, Dhillon MS. Neglected, semimembranosus osteochondral avulsion fracture of the posteromedial tibial plateau. Trauma Case Rep. 2018;15:16-22. doi: 10.1016/j.tcr.2018.04.004. [PubMed: 29876497]. [PubMed Central: PMC5987264].
9. Strobel MJ. Knee joint-special part. In: Strobel MJ, editor. Manual of arthroscopic surgery. Berlin, Heidelberg, Germany: Springer Berlin Heidelberg; 2002. p. 97-669.
10. Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am. 1973;55(7):1331-50. [PubMed: 4586086].
11. Trentacosta N, Graham WC, Gersoff WK. Meniscal allograft transplantation: state of the art. Sports Med Arthrosc Rev. 2016;24(2):e23-e33. doi:00132585-201606000-00002. [PubMed: 27135295].
12. Cavaignac E, Sylvie R, Teulieres M, Fernandez A, Frosch KH, Gomez-Brouchet A, et al. What is the relationship between the distal semimembranosus tendon and the medial meniscus? A gross and microscopic analysis from the SANTI Study Group. Am J Sports Med. 2021;49(2):459-66. doi: 10.1177/0363546520980076. [PubMed: 33332976].
13. Yoon KH, Yoo JH, Kim KI. Bone contusion and associated meniscal and medial collateral ligament injury in patients with anterior cruciate ligament rupture. J Bone Joint Surg Am. 2011;93(16):1510-8. doi: 10.2106/JBJS.J.01320. [PubMed: 22204006].
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IssueVol 10 No 3 (2024) QRcode
SectionCase Report
DOI https://doi.org/10.18502/jost.v10i3.16787
Keywords
Medial Meniscus Case Reports Knee Injuries Tibial Plateau Fractures
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How to Cite
1.
Sharafat Vaziri A, Rabie H, Menbari Oskouie I, Tahami M, Rahimdoost N. A Case Report of a Rare Presentation of Semimembranosus Tibial Plateau Avulsion: The Bony Ramp Lesion. J Orthop Spine Trauma. 2024;10(3):135-8.