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. 2024 Apr 8;12(4):23259671241238023.
doi: 10.1177/23259671241238023. eCollection 2024 Apr.

Incidence and Characteristics of Knee Ligament and Meniscal Injuries in Patients With Posterolateral Tibial Plateau Fractures

Binghao Wang  1 , Yi Zhu  1 , Binbin Zhang  1 , Yukai Wang  1 , Lifeng Yan  1 , Xuetao Xie  1 , Congfeng Luo  1
Affiliations

Incidence and Characteristics of Knee Ligament and Meniscal Injuries in Patients With Posterolateral Tibial Plateau Fractures

Binghao Wang et al. Orthop J Sports Med. .

Abstract

Background: Anterior cruciate ligament (ACL) tears are commonly seen with concomitant injuries to the posterolateral tibial plateau, while the occurrence of ACL injuries in posterolateral tibial plateau fractures (PTPFs) remains unclear.

Purpose: To (1) explore the incidence of knee ligament (anterior or posterior cruciate ligament, medial or lateral collateral ligament) and medial or lateral meniscus injuries in patients with PTPF and (2) find reliable PTPF-related parameters to predict the risk of knee ligament and meniscal injuries.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: Patients diagnosed with PTPF who had computed tomography and magnetic resonance imaging (MRI) data were identified. Morphological parameters of the PTPF were measured on sagittal computed tomography images. Knee ligament and meniscal injuries were assessed using MRI. The association of ACL injuries with meniscal injuries was analyzed. Receiver operating characteristic (ROC) analysis was used to determine the value and cutoff point of the PTPF morphological parameters for diagnosing complete in-substance ACL tears.

Results: Overall, 113 patients with PTPF were included. ACL injuries were present in 94 (83.2%) patients, including 43 (38.1%) avulsion fractures and 28 (24.8%) complete in-substance tears. Patients with in-substance ACL tears had a higher incidence of lateral meniscus posterior horn tears compared with the other patients (PBonferroni < .001). ROC analysis revealed that both the fracture depression angle (cutoff point, 25.5°) and the posterior articular surface loss percentage (cutoff point, 37.5%) had a sensitivity >90% and a specificity >80% for the diagnosis of complete in-substance ACL tears.

Conclusion: ACL injuries were seen in 83.2% of the study patients. Complete in-substance ACL tears were associated with an increased incidence of lateral meniscus posterior horn tears. Among PTPF parameters, fracture depression angle and posterior articular surface loss percentage showed a high predictive value for the presence of complete in-substance ACL tears, thereby reducing delays in diagnosis and treatment.

Keywords: anterior cruciate ligament; lateral meniscus; magnetic resonance imaging; tibial plateau fracture.

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Conflict of interest statement

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from the Ethics Committee of Shanghai Sixth People's Hospital (reference No. 2023-033).

Figures

Figure 1.
Figure 1.
Flowchart demonstrating patient exclusion and inclusion. CT, computed tomography; MRI, magnetic resonance imaging.
Figure 2.
Figure 2.
Measurement of posterolateral tibial plateau fracture morphological parameters. Posterior articular surface loss percentage was defined as the ratio of the distance between points P and O to the distance between points R and O. Articular surface depression depth is recorded as the distance between points Q and O. Fracture depression angle is defined as the angle between lines A and C.
Figure 3.
Figure 3.
Incidence of tears in different regions of the meniscus.
Figure 4.
Figure 4.
Receiver operating characteristic curves showing the area under the curve (AUC) for fracture depression angle and posterior articular surface loss percentage.
Figure A1.
Figure A1.
Mosaic plots demonstrating the percentage of patients with (A) medial meniscus (MM) injuries and (B) lateral meniscus (LM) injuries according to anterior cruciate ligament (ACL) injury pattern distribution.
Figure A2.
Figure A2.
Two-dimensional scatterplot demonstrating the association between fracture morphology parameters and complete in-substance anterior cruciate ligament tears. The red line represents the cutoff value based on the receiver operating characteristic curve analysis.
See this image and copyright information in PMC

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