Arthroscopic evaluation for tibial plateau fractures on the incidence and types of cruciate ligamentous injuries following closed reduction and internal fixation.

Abstract

To evaluate the overall incidence and types of anterior cruciate ligament (ACL) injuries and posterior cruciate ligament (PCL) injuries associated with tibial plateau fractures (TPFs) following closed reduction and internal fixation (CRIF), and to identify the relationship between the incidence and types of cruciate ligamentous injuries with Schatzker classification and "three-column" classification. From January 2016 to January 2018, 185 patients with closed TPFs who underwent CRIF were included in this retrospective study. All patients were performed with arthroscopic examination after CRIF, and then, the incidence and types of cruciate ligamentous injuries were recorded and evaluated. The overall incidence rates of cruciate ligamentous injuries associated with TPFs were 37.3% with 21.6% of these being ACL injuries and 15.7% had PCL injuries. Importantly, patients with fractures in "two-column" fractures have a significantly higher incidence rate of ACL avulsion fracture and PCL complete tears (P < 0.05) than other fracture types, especially involving anteromedial and posterior column fractures. In addition, the incidence of PCL partial tears in patients with three-column involvement was 11.8%, which was higher than other fracture patterns based on three-column classification system (P < 0.05). In the current study, Schatzker IV was most commonly associated with ACL injuries, occurring in 48.1% of our series. Furthermore, PCL injuries occurred at a significantly higher incidence in Schatzker VI with 34.5% than other fracture types (P < 0.05). Statistical analysis revealed that there was a significant difference between Schatzker classification and incidence of injury to the ACL (P < 0.05) and PCL (P < 0.05). Of note, avulsion fracture was the most common types of ACL injuries which was observed in 45% ACL injuries, while partial tear was the most common types of PCL injuries. However, no significant relationship was identified between the types of cruciate ligamentous injuries and Schatzker classification (P> 0.05). In the recognition of concomitant cruciate ligamentous injuries associated with TPFs based on Schatzker classification and three-column classification, orthopaedic trauma surgeons may better guide optimal surgical protocols for patients.