Abstract
BackgroundThere is a great deal of controversy on whether routine MRI examination is needed for fresh fractures while the vast majority of patients with tibial plateau fractures (TPFs) receive preoperative X-ray and CT examinations. The purpose of the study was to analyze the exact correlation between CT images of lateral plateau and lateral meniscus injuries in Schatzker II TPFs.MethodsA total of 296 patients with Schatzker II TPFs from August 2012 to January 2021 in two trauma centers were enrolled for the analysis. According to the actual situation during open reduction internal fixation (ORIF) and knee arthroscopic surgery, patients were divided into meniscus injury (including rupture, incarceration, etc.) and non-meniscus injury groups. The values of both lateral plateau depression (LPD) and lateral plateau widening (LPW) of lateral tibial plateau on CT images were measured, and their correlation with lateral meniscus injury was then analyzed. The relevant receiver operating characteristic (ROC) curve was drawn to evaluate the optimal cut-off point of the two indicators which could predict meniscus injury.ResultsThe intra- and inter-observer reliabilities of LPD and LPW were acceptable (intraclass correlation coefficient (ICC) > 0.8). The average LPD was 13.2 ± 3.2 mm while the average value of the group without meniscus injury was 9.4 ± 3.2 mm. The difference between the two groups was statistically significant (P < 0.05). The average LPW was 8.0 ± 1.4 mm and 6.8 ± 1.6 mm in meniscus injury and non-meniscus injury groups with a significant difference (P < 0.05). The optimal predictive cut-off value of LPD and LPW was 7.9 mm (sensitivity-95.0%, specificity-58.8%, area under the curve (AUC-0.818) and 7.5 mm (sensitivity-70.0%, specificity - 70.6%, AUC - 0.724), respectively. The meniscus injury group mainly showed injuries involving the mid-body and posterior horn of lateral meniscus (98.1%, 157/160).ConclusionsThe mid-body and posterior horn of lateral meniscus injury is more likely to occur in patients with Schatzker II TPFs when LPD > 7.9 mm and/or LPW > 7.5 mm on CT. These findings will definitely provide guidance for orthopedic surgeons in treating such injuries. During the operation, more attention is required be paid to the treatment of the meniscus and the possible fracture reduction difficulties and poor alignment caused by meniscus rupture and incarceration should be fully considered in order to achieve better surgical results.
Highlights
There is a great deal of controversy on whether routine magnetic resonance imaging (MRI) examination is needed for fresh fractures while the vast majority of patients with tibial plateau fractures (TPFs) receive preoperative X-ray and CT examinations
According to the Chinese experts’ consensus on the diagnosis and treatment of TPFs published in 2015 [6], there is a great deal of controversy on whether routine MRI examination is needed for fresh fractures
Some clinical studies have pointed out that preoperative knee X-ray and CT examination can indicate TPFs combined with soft tissue injury, especially meniscus injury [7,8,9,10,11,12,13]
Summary
There is a great deal of controversy on whether routine MRI examination is needed for fresh fractures while the vast majority of patients with tibial plateau fractures (TPFs) receive preoperative X-ray and CT examinations. Tibial plateau fractures (TPFs) are usually accompanied by injuries of soft tissues including the medial and lateral meniscus, medial and lateral collateral ligaments, and anterior and posterior cruciate ligaments [1] Under these conditions, early diagnosis and treatment of meniscus and ligament injuries can often provide a better prognosis of knee function [2,3,4]. The identification of soft tissue damage often depends on imaging examinations and intraoperatively direct or arthroscopic explorations In this regard, magnetic resonance imaging (MRI) has been confirmed to have unique advantages in the diagnosis of meniscus and ligament injuries of the knee joint [5]. Some clinical studies have pointed out that preoperative knee X-ray and CT examination can indicate TPFs combined with soft tissue injury, especially meniscus injury [7,8,9,10,11,12,13]
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