Incidence and Radiological Predictors of Concomitant Meniscal and Cruciate Ligament Injuries in Operative Tibial Plateau Fractures: A Prospective Diagnostic Study

Hengrui Chang,Hengrui Chang,Zhanle Zheng,Zhanle Zheng,Decheng Shao,Decheng Shao,Yingze Zhang,Yingze Zhang,Zhiyong Hou,Zhiyong Hou,Yiyang Yu,Yiyang Yu

doi:10.1038/s41598-018-31705-x

Hengrui Chang, Hengrui Chang + Show 10 more

Open Access

https://doi.org/10.1038/s41598-018-31705-x

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Abstract

The aim of this prospective study was to determine the incidence of meniscal and cruciate ligament injuries in operative tibial plateau fractures detected using knee arthroscopy, and to identify the radiological predictors observed on CT images. From January 2016 to February 2017, a total of 102 closed tibial plateau fractures were enrolled in this prospective protocol. Each patient underwent arthroscopic examination following the tibial plateau internal fixation. Univariate analysis and multivariable logistic regression were used to assess the association between imaging parameters and soft-tissue injuries. The menisci were traumatically injured in 52.9% of subjects (54 of 102) and the cruciate ligaments injured in 22.5% (23 of 102). Significantly higher injury rates for bucket-handle meniscal tears were observed in Schatzker type VI fractures (P = 0.04). Greater risk of lateral meniscus injury was observed in patients with >6.3 mm of lateral joint depression. Greater risk of ACL injury when the volumetric lateral joint depression was ≤209.5 mm2 and/or with >5.7 mm lateral joint widening. Associated meniscal and ligament injuries were commonly seen among operative tibial plateau fractures. Preoperative CT measurements might help predict a higher risk of meniscus and ACL injury, providing guidance to the surgeon to look for and to be prepared to treat such injuries.

Highlights

At the end of 2015, we began to perform percutaneous treatment for tibial plateau fractures using the self-designed traction device
The independent variables include age, sex, energy level of injury (Schatzker type I to III were classified as the low-energy fracture patterns and Schatzker type IV to VI were classified as the high-energy fracture patterns)[13,18,19], the depth of lateral plateau depression, the area of lateral plateau depression, lateral plateau widening (LPW), the depth of medial plateau depression, the area of medial plateau depression, and medial plateau widening (MPW)
Peripheral tear was the most common type of meniscal injury which was noted in 24 fractures and was most frequent in lateral meniscus

Summary

Introduction

At the end of 2015, we began to perform percutaneous treatment for tibial plateau fractures using the self-designed traction device. Because a traditional arthrotomy was not performed with this technique, arthroscopic examination was performed for each patient in order to evaluate for intra-articular soft tissue injures. The purpose of this prospective study was twofold: (1) to determine the incidence of meniscal and cruciate ligament injuries in tibial plateau fractures detected by diagnostic arthroscopy, and (2) to correlate these soft tissue injuries with measurements of displacement on computed tomography (CT) images, in order to indentify radiological predictors of associated meniscal and cruciate ligament injury

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