Repair of meniscal tears associated with tibial plateau fractures: a review of 15 cases

Abstract

Background: Tibial plateau fractures are frequently associated with meniscal tears. Little is known about the results of meniscal repair in this group of patients.

Purpose: To determine the results of repair of meniscal tears found during arthroscopically assisted reduction and internal fixation (ARIF) of tibial plateau fractures.

Study design: Case series; Level of evidence, 4.

Methods: In a cohort of 51 tibial plateau fractures treated with ARIF, 15 associated meniscal tears (15 knees) in 14 patients were repaired. There were 12 peripheral longitudinal tears of the lateral meniscus, 1 longitudinal peripheral tear of the medial meniscus, 1 full-thickness radial tear of the lateral meniscus, and 1 bird-beak tear of the lateral meniscus. Repairs were performed using an outside-in technique for the anterior horn and all-inside repair for the body and posterior horn lesions. Mean (SD) age at operation was 47.3 (14.0) years. Patients were followed for a mean (SD) of 4.83 (1.01) years and evaluated using the Rasmussen, Honkonen, Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores. A second-look arthroscopy was performed in 13 knees a mean (SD) of 14.2 (10.1) months after the initial surgery.

Results: The mean (SD) Rasmussen score was 29.1 (0.96). Thirteen of 15 patients scored good or excellent results in all Honkonen sections. The mean (SD) Lysholm score was 88.6 (12.4). The mean (SD) IKDC score was 79.3 (19.3). There was a small decrease of the activity level according to the Tegner score when compared with the preoperative situation (1.20 [1.82], P = .022). There were not any meniscal symptoms in any case. Of the 13 menisci evaluated with second-look arthroscopy, 12 had healed completely and a radial tear had healed partially in the vascular zone. In one of the cases that healed, a new tear was found in a different location.

Conclusion: Meniscal repair of tears associated with tibial plateau fractures has good results. All patients had good or excellent clinical results. Second-look arthroscopy confirmed complete healing in 92% of meniscal tears when performed.