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What is the Radiographic Factor Associated with Meniscus Injury in Tibial Plateau Factures? Multicenter Retrospective (TRON) Study

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Abstract

Purpose

Tibial plateau fracture (TPF) is a complex intra-articular injury involving comminution and depression of the joint, which can be accompanied by meniscal tears. The aims of this study were (1) to demonstrate the rate at which surgical treatment for lateral meniscal injury and (2) to clarify the explanatory radiographic factors associated with meniscal injury in patients with TPF.

Methods

We extracted the patients who received surgical treatment for TPF from our multicenter database (named TRON) included from 2011 to 2020. We analyzed 79 patients who were received surgical treatment for TPF with Schatzker type II and III and evaluation for meniscal injury on arthroscopy. We investigated the rate at which surgical treatment of the lateral meniscus was required in patients with TPF and the explanatory radiographic factors associated with meniscal injury. Radiographs and CT scans were evaluated to measure the following parameters: tibial plateau slope, distance from lateral edge of the articular surface to fracture line (DLE), articular step, and width of articular bone fragment (WDT). Meniscus tears were classified according to whether surgery was necessary. The results were analyzed by multivariate Logistic analyses.

Results

We showed that 27.7% (22/79) of cases of TPF with Schatzker type II and III had lateral meniscal injury that required repair. WDT ≥ 10 mm (odds ratio 10.9; p = 0.005) and DLE ≥ 5 mm (odds ratio 5.7; p = 0.05) were independent explanatory factors for meniscal injury with TPF.

Conclusion

Bone fragment size and the location of fracture line on radiographs in patients with TPF are associated with meniscus injuries requiring surgery.

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Data availability statement

The data that supports the findings of this study are available in the supplementary material of this article.

References

  1. Schatzker, J., McBroom, R., & Bruce, D. (1979). The tibial plateau fracture. The Toronto experience 1968–1975. Clinical Orthopaedics and Related Research, 1979, 94–104.

    Google Scholar 

  2. Barrow, B. A., Fajman, W. A., Parker, L. M., Albert, M. J., Drvaric, D. M., & Hudson, T. M. (1994). Tibial plateau fractures: Evaluation with MR imaging. Radiographics, 14, 553–559. https://doi.org/10.1148/radiographics.14.3.8066271

    Article  CAS  PubMed  Google Scholar 

  3. Bennett, W. F., & Browner, B. (1994). Tibial plateau fractures: A study of associated soft tissue injuries. Journal of Orthopaedic Trauma, 8, 183–188.

    Article  CAS  PubMed  Google Scholar 

  4. Böhler, L. (1958). The treatment of fractures (Vol. 3). Grime & Stratton.

    Google Scholar 

  5. Beaufils, P., & Pujol, N. (2017). Management of traumatic meniscal tear and degenerative meniscal lesions. Save the meniscus. Orthopaedics & Traumatology, Surgery & Research, 103, S237–S244. https://doi.org/10.1016/j.otsr.2017.08.003

    Article  CAS  Google Scholar 

  6. Li, L., Yang, L., Zhang, K., Zhu, L., Wang, X., & Jiang, Q. (2019). Three-dimensional finite-element analysis of aggravating medial meniscus tears on knee osteoarthritis. Journal of Orthopaedic Translation, 20, 47–55. https://doi.org/10.1016/j.jot.2019.06.007

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gardner, M. J., Yacoubian, S., Geller, D., Pode, M., Mintz, D., Helfet, D. L., & Lorich, D. G. (2006). Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs. Journal of Trauma, 60, 319–324. https://doi.org/10.1097/01.ta.0000203548.50829.92

    Article  PubMed  Google Scholar 

  8. Salari, P., Busel, G., & Watson, J. T. (2021). A radiographic zone-based approach to predict meniscus injury in lateral tibial plateau fracture. Injury, 52, 1539–1543. https://doi.org/10.1016/j.injury.2020.10.022

    Article  PubMed  Google Scholar 

  9. Wang, J., Wei, J., & Wang, M. (2015). The distinct prediction standards for radiological assessments associated with soft tissue injuries in the acute tibial plateau fracture. European Journal of Orthopaedic Surgery & Traumatology, 25, 913–920. https://doi.org/10.1007/s00590-015-1614-5/

    Article  Google Scholar 

  10. Durakbasa, M. O., Kose, O., Ermis, M. N., Demirtas, A., Gunday, S., & Islam, C. (2013). Measurement of lateral plateau depression and lateral plateau widening in a Schatzker type II fracture can predict a lateral meniscal injury. Knee Surgery, Sports Traumatology, Arthroscopy, 21(9), 2141–2146. https://doi.org/10.1007/s00167-012-2195-z

    Article  PubMed  Google Scholar 

  11. Spiro, A. S., Regier, M., Novo de Oliveira, A., Vettorazzi, E., Hoffmann, M., Petersen, J. P., Henes, F. O., Demuth, T., Rueger, J. M., & Lehmann, W. (2013). The degree of articular depression as a predictor of soft-tissue injuries in tibial plateau fracture. Knee Surgery, Sports Traumatology, Arthroscopy, 21, 564–570. https://doi.org/10.1007/s00167-012-2201-5

    Article  PubMed  Google Scholar 

  12. Mui, L. W., Engelsohn, E., & Umans, H. (2007). Comparison of CT and MRI in patients with tibial plateau fracture: Can CT findings predict ligament tear or meniscal injury? Skeletal Radiology, 36, 145–151. https://doi.org/10.1007/s00256-006-0216-z

    Article  PubMed  Google Scholar 

  13. Omichi, T., Takegami, Y., Tokutake, K., Saito, Y., Ito, O., Ando, T., & Imagama, S. (2022). Mortality and functional outcomes of fragility fractures of the pelvis by fracture type with conservative treatment: a retrospective, multicenter TRON study. European Journal of Trauma and Emergency Surgery, 48, 2897–2904. https://doi.org/10.1007/s00068-021-01839-1.

  14. Kim, K. H., Bin, S. I., & Kim, J. M. (2012). The correlation between posterior tibial slope and maximal angle of flexion after total knee arthroplasty. Knee Surgery and Related Research., 24(3), 158–163. https://doi.org/10.5792/ksrr.2012.24.3.158

    Article  PubMed  PubMed Central  Google Scholar 

  15. Arnoczky, S. P., Warren, R. F., & McDevitt, C. A. (1990). Meniscal replacement using a cryopreserved allograft. An experimental study in the dog. Clinical Orthopaedics and Related Research, 252, 121–128.

    Article  Google Scholar 

  16. Fairbank, T. J. (1948). Knee joint change after meniscectomy. Journal of Bone and Joint Surgery, 30, 664–670.

    Google Scholar 

  17. Beaufils, P., Hulet, C., Dhénain, M., Nizard, R., Nourissat, G., & Pujol, N. (2009). Clinical practice guidelines for the management of meniscal lesions and isolated lesions of the anterior cruciate ligament of the knee in adults. Orthopaedics & Traumatology, Surgery & Research, 95, 437–442. https://doi.org/10.1016/j.otsr.2009.06.002

    Article  CAS  Google Scholar 

  18. Jackson, R. W., & Dandy, D. J. (1976). Arthroscopy of the knee. Grune Stratton.

    Google Scholar 

  19. Weiss, C. B., Lundberg, M., Hamberg, P., DeHaven, K. E., & Gillquist, J. (1989). Non-operative treatment of meniscal tears. Journal of Bone and Joint Surgery. American Volume, 71(6), 811–822.

    Article  CAS  PubMed  Google Scholar 

  20. Kanda, Y. (2013). Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplantation, 48, 452–458. https://doi.org/10.1038/bmt.2012.244

    Article  CAS  PubMed  Google Scholar 

  21. Honkonen, S. (1995). Degenerative arthritis after tibial plateau fractures. Journal of Orthopaedic Trauma, 9(4), 273–277. https://doi.org/10.1097/00005131-199509040-00001

    Article  CAS  PubMed  Google Scholar 

  22. Hung, S. S., Chao, E. K., Chan, Y. S., Yuan, L. J., Chung, P. C., Chen, C. Y., Lee, M. S., & Wang, C. J. (2003). Arthroscopically assisted osteosynthesis for tibial plateau fractures. Journal of Trauma, 54, 356–363. https://doi.org/10.1097/01.TA.0000020397.74034.65

    Article  PubMed  Google Scholar 

  23. van Glabbeek, F., van Riet, R., Jansen, N., D’Anvers, J., & Nuyts, R. (2002). Arthroscopically assisted reduction and internal fixation of tibial plateau fractures: Report of twenty cases. Acta Orthopaedica Belgica, 68, 258–64.

    PubMed  Google Scholar 

  24. Yoshioka, Y., Siu, D. W., Scudamore, R. A., & Cooke, T. D. (1989). Tibial anatomy and functional axes. Journal of Orthopaedic Research, 7, 132–7. https://doi.org/10.1002/jor.1100070118

    Article  CAS  PubMed  Google Scholar 

  25. Fox, A. J., Bedi, A., & Rodeo, S. A. (2012). The basic science of human knee menisci: structure, composition, and function. Sports health, 4, 340–351. https://doi.org/10.1177/1941738111429419

  26. Bae, J. Y., Park, K. S., Seon, J. K., Kwak, D. S., Jeon, I., & Song, E. K. (2012). Biomechanical analysis of the effects of medial meniscectomy on degenerative osteoarthritis. Medical & Biological Engineering & Computing, 50, 53–60. https://doi.org/10.1007/s11517-011-0840-1

    Article  Google Scholar 

  27. Vangsness, C. T., Jr., Ghaderi, B., Hohl, M., & Moore, T. M. (1994). Arthroscopy of meniscal injuries with tibial plateau fractures. Journal of Bone and Joint Surgery. British Volume, 76, 488–490.

    Article  PubMed  Google Scholar 

  28. Alici, T., Esenyel, C. Z., Esenyel, M., Imren, Y., Ayanoglu, S., & Cubuk, R. (2011). Relationship between meniscal tears and tibial slope on the tibial plateau. The Eurasian Journal of Medicine, 43, 146–151. https://doi.org/10.5152/eajm.2011.35

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank to Dr. Tokumi Kanemura, Dr. Takeshi Oguchi, Dr. Takaaki Shinohara, Dr. Katsuhiro Taguchi, Dr. Nobuyuki Okui, Dr. Tadahiro Sakai, Dr. Kenichi Yamauchi, Dr. Yasuhide Kanayama Dr. Hiroaki Kumagai, Dr, Eiji Ozawa, Tetsuro Takatsu, Dr. Yuji Matsubara and Dr. Hidenori Inoue for data collection. Special thanks to Dr. Kenya Iwase, Dr. Hiroki Yokoyama, Dr. Yasutaka Oshika and Dr. Kohei Tanaka for cooperation.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Keita Naruse, Yasuhiko Takegami, Keita Shimizu, Yoshito Sudo & Shiro Imagama

  2. Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Katsuhiro Tokutake

  3. Department of Orthopedic Surgery, Daido Hospital, Nagoya, Japan

    Takaaki Shinohara

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  1. Keita Naruse
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  2. Yasuhiko Takegami
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  3. Katsuhiro Tokutake
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  4. Keita Shimizu
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  5. Yoshito Sudo
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Contributions

KN: Data collection and assessment, study design, writing the paper. YT: Manuscript preparation, study and conception design. TS: Conception design. KT: Manuscript preparation, study design. KS and YS: Data collection and assessment, manuscript preparation. SI: Conception design, guarantor.

Corresponding author

Correspondence to Yasuhiko Takegami.

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Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Ethics Approval

This study also received institutional ethical approval (reference number 2020-564). The registry also received ethical approval from all participating institutions.

Informed consent

All eligible patients were registered using an opt-out consent process. Patients were provided with a letter and a brochure informing them that they had been registered, the purpose of the registration, and the procedure to remove themselves from the registry.

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Naruse, K., Takegami, Y., Tokutake, K. et al. What is the Radiographic Factor Associated with Meniscus Injury in Tibial Plateau Factures? Multicenter Retrospective (TRON) Study. JOIO 57, 1076–1082 (2023). https://doi.org/10.1007/s43465-023-00888-5

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  • DOI: https://doi.org/10.1007/s43465-023-00888-5

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