scholarly journals Prediction of Meniscal and Ligamentous Injuries in Lateral Tibial Plateau Fractures Based on Measurements of Lateral Plateau Widening on Multidetector Computed Tomography Scans

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Jan P. Kolb ◽  
Marc Regier ◽  
Eik Vettorazzi ◽  
Norbert Stiel ◽  
Jan P. Petersen ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Multidetector Ct ◽  
Lateral Meniscus ◽  
Case Series ◽  
Lateral Collateral Ligament ◽  
Tibial Plateau Fractures ◽  
Lateral Tibial Plateau ◽  
Plain Radiographs ◽  
Lateral Plateau

Background. The influence of increasing lateral plateau widening on the frequency of meniscal and ligamentous lesions in lateral tibial plateau fractures has been examined in very few studies using plain radiographs. Because the amount of this parameter cannot be measured accurately on plain radiographs, the purpose of this survey was to look for a possible correlation between the extent of lateral plateau widening, as measured on multidetector CT (MDCT) scans, and different soft-tissue injuries determined from magnetic resonance imaging (MRI). Materials and Methods. 55 patients with a lateral tibial plateau fracture were included in this retrospective case series. Patient age averaged 52.6 years (SD = 18.0). The degree of lateral plateau widening was measured on CT images. MRIs were screened for meniscal and ligamentous injuries. Results. We found a significant effect of increasing lateral plateau widening on the incidence of lateral meniscus lesions (P = 0.021), lateral collateral ligament tears (P = 0.047), and the overall quantity of meniscal and ligamentous lesions (P = 0.001). Discussion. MRIs are not widely used as a diagnostic tool in lateral plateau fractures of the tibia. Reasons might be the costs and the fact that it is a time-consuming examination. The results of this study may help to estimate the probability of specific soft-tissue lesions in lateral tibial plateau fractures based on measurements of lateral plateau widening on MDCT scans, and they may guide the decision for additional MRI and/or arthroscopically assisted repair.

scholarly journals Early Results of the Medial Approach for Arthroscopic-Assisted Fixation of Lateral Tibial Plateau Fractures

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0004
Author(s):  
Tunay Erden ◽  
Suat Batar ◽  
Gökçer Uzer ◽  
Demet Pepele Kurdal ◽  
Nurzat Elmalı
Keyword(s):  
Tibial Plateau ◽  
Soft Tissues ◽  
Lateral Meniscus ◽  
Case Series ◽  
Tibial Plateau Fractures ◽  
Meniscus Tear ◽  
Type I ◽  
Lateral Tibial Plateau ◽  
Schatzker Type ◽  
Diagnostic Arthroscopy

The use of arthroscopy in the management of tibial plateau fractures is not a particularly new concept. It has been used successfully for Schatzker types I–III fractures. In addition to evaluating the fracture itself, it is easier to evaluate the other intraarticular structures. Coventionally, reduction for lateral tibial plateau fractures have been performed through a laterally based metaphyseal window, which is not without limitations, including difficulty with reduction of the fracture, as well as bone grafting though the resultant short subchondral tunnel. Also, there is a risk of lateral vascular supply distrubtion because of same side fracture. A medially based metaphyseal window to approach lateral tibial plateau fractures allows for minimal insult to the soft tissues, with advantageous ease of reduction and grafting through a longer tunnel for subchondral support. We aimed to present our initial experiences in twelwe cases approaching lateral tibial plateau fractures through a medial metaphyseal window. Material-Methods: Our series involves 12 patients with 7 Schatzker type II, 3 Schatzker type I, and 2 Schatzker type III fractures. There were 8 males and 4 females. The average age at the time of surgery was 37 (25-57) years. All of the patients underwent plain radiography and BT in each knee Time from injury to surgery was 6.2 days. Follow up was 18 months (9-22 months).Firstly diagnostic arthroscopy was performed. Concomittant pathology was adreessed as needed. There was 3 lateral meniscus tear that treated with partial meniscectomy. An ACL guide pin was placed percutaneously anteromedial tibia approximately 9 cm distal to the joint line. Once stisfactory positioning a cortical window 1x2 cm. made around the guide pin. Reduction was accomplished with a bone tamp that fits easily into the tunnel. Screws were used as rafters to support the articular surface and subchondral bone. We used in 7 patients lateral plate and screws and in 5 patients only screws. Care was taken to keep pump pressure at approximately 40 millimeters of mercury for alleviate the risk of compartment syndrome. Results: No complications related to the procedure were observed. No secondary loss of reduction was observed in radiological controls. Functional assessment according to HSS of the patients were excellent in 5 cases, good in 5 cases and fair 2 cases. Discussion: Because depressed fragments are elevated from distal cortical windows, the importance of an intact, or easily restored, “cortical envelope” is paramount. This case series showed satisfactory early clinical results. [Figure: see text][Figure: see text]

scholarly journals The concept of direct approach to lateral tibial plateau fractures and stepwise extension as needed

2020 ◽  
Vol 46 (6) ◽  
pp. 1211-1219 ◽  
Author(s):  
Karl-Heinz Frosch ◽  
Alexander Korthaus ◽  
Darius Thiesen ◽  
Jannik Frings ◽  
Matthias Krause
Keyword(s):  
Prone Position ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Lateral Meniscus ◽  
Tibial Plateau Fractures ◽  
Posterolateral Approach ◽  
Central Segment ◽  
Anatomic Reduction ◽  
Lateral Plating ◽  
Lateral Plateau

AbstractMalreduction after tibial plateau fractures mainly occurs due to insufficient visualization of the articular surface. In 85% of all C-type fractures an involvement of the posterolateral-central segment is observed, which is the main region of malreduction. The choice of the approach is determined (1) by the articular area which needs to be visualized and (2) the positioning of the fixation material. For simple lateral plateau fractures without involvement of the posterolateral-central segment an anterolateral standard approach in supine position with a lateral plating is the treatment of choice in most cases. For complex fractures the surgeon has to consider, that the articular surface of the lateral plateau only can be completely visualized by extended approaches in supine, lateral and prone position. Anterolateral and lateral plating can also be performed in supine, lateral and prone position. A direct fixation of the posterolateral-central segment by a plate or a screw from posterior can be only achieved in prone or lateral position, not supine. The posterolateral approach includes the use of two windows for direct visualization of the fracture. If visualization is insufficient the approach can be extended by lateral epicondylar osteotomy which allows exposure of at least 83% of the lateral articular surface. Additional central subluxation of the lateral meniscus allows to expose almost 100% of the articular surface. The concept of stepwise extension of the approach is helpful and should be individually performed as needed to achieve anatomic reduction and stable fixation of tibial plateau fractures.

Prediction of Soft-Tissue Injuries in Schatzker II Tibial Plateau Fractures based on Measurements of Plain Radiographs

2006 ◽  
Vol 60 (2) ◽  
pp. 319-324 ◽  
Author(s):  
Michael J. Gardner ◽  
Shahan Yacoubian ◽  
David Geller ◽  
Matthew Pode ◽  
Douglas Mintz ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Soft Tissue Injuries ◽  
Tibial Plateau Fractures ◽  
Plain Radiographs ◽  
Tissue Injuries

scholarly journals Correlation Between CT Images of Lateral Plateau and Lateral Meniscus Injuries in Patients With Schatzker II Tibial Plateau Fractures：A Retrospective Study

2021 ◽  
Author(s):  
Pu Ying ◽  
Lei Zhu ◽  
Wenge Ding ◽  
Yue Xu ◽  
Xiaowei Jiang ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Lateral Meniscus ◽  
Ct Images ◽  
Tibial Plateau Fractures ◽  
Posterior Horn ◽  
Operating Point ◽  
Optimal Operating ◽  
Meniscus Injury ◽  
Lateral Plateau ◽  
Meniscus Injuries

Abstract Background: 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 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 tibial plateau fractures. Methods: Two hundred and ninety-six Schatzker II tibial plateau fracture patients 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. By measuring the value of both lateral plateau depression (LPD) and lateral plateau widening (LPW) of lateral tibial plateau on the coronary CT images, the correlation of which and lateral meniscus injury was analyzed. Meanwhile, the relevant receiver operating characteristic (ROC) curve was drawn to evaluate the optimal operating point of these two indicators which could predict meniscus injury. Results: Meniscus injury group mainly showed injuries involving the mid-body and posterior horn of the meniscus (98.1%, 157/160). 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 was statistically significant (P < 0.05). The average LPW was 8.0 ± 1.4 mm and 6.8 ± 1.6 mm in two groups with a significant difference (P < 0.05). The optimal operating point 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. Conclusions: The mid-body and posterior horn of lateral meniscus injury is more likely to occur in patients who had Schatzker II tibial plateau fractures when LPD > 7.9 mm and/or LPW > 7.5 mm on CT manifestations and these findings will definitely provide guidance for orthopedic surgeons in treating such injuries. During the operation, more attention should be paid to the treatment of the meniscus and full consideration is needed be taken to situations such as meniscus rupture, incarceration and other possible fracture reduction difficulties, poor vertical line, etc., in order to achieve better surgical results.

scholarly journals Comparison of articular exposure through extended lateral approaches to the tibial plateau

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0031
Author(s):  
Jannik Frings ◽  
Matthias Krause ◽  
Hüseyin Isik ◽  
Karl-Heinz Frosch
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Lateral Collateral Ligament ◽  
Joint Surface ◽  
Anatomical Reconstruction ◽  
Anterolateral Approach ◽  
Popliteus Tendon ◽  
Lateral Tibial Plateau ◽  
Lateral Epicondyle

Aims and Objectives: Comminuted lateral tibial plateau fractures pose a challenge to surgeons, resulting in non-anatomical reductions in 70-89% of all cases. Anatomical reconstruction requires the direct visualization of the joint after a fragment reduction, which is impaired using the common anterolateral approach. Although numerous lateral extended approaches are described, there is currently no data on which approach provides better visibility of the posterolateral tibial plateau. The aim of this study was to evaluate, which parts of the tibial plateau can be visualized with the use of the lateral femoral epicondyle osteotomy or the fibula osteotomy? Further, the study investigated wether the combined osteotomy of the femoral footprints of the lateral collateral ligament (LCL) and popliteus tendon (PLT) provide better access to the posterolateral joint surface than the isolated osteotomy of the femoral LCL footprint or the fibula osteotomy? Materials and Methods: Extended lateral (femoral or fibular LCL osteotomy) and posterolateral (additional femoral osteotomy of the PLT tendon) approaches were performed on twelve human cadaver knee joints. After preparing of each surgical approach, the visible joint surface was marked with diathermy. The tibial plateau was disarticulated and the markings were measured digitally with open-source processing software. Differences in mean values were tested with a paired t-test (p < 0.05). Results: The greatest articular exposition was realized by the fibula osteotomy (1011.52 ± 227.05 mm2 [86.64 ± 4.84%] compared to either osteotomy of LCL and PLT (p = 0.036) or LCL alone (p<0.001). The lateral femoral epicondyle osteotomy of the LCL including the PLT (937.45 ± 237.84 mm2 [80.29 ± 8.25 %]) exposed a significantly larger articular surface of the lateral tibial plateau than without the PLT (755.71 ± 183.06 mm2 [64.73 ± 6.51 %], p < 0.001). Conclusion: The fibula osteotomy provides the greatest articular visibility of the lateral tibial plateau compared to the lateral epicondyle osteotomy of the femoral LCL and PLT attachments. This small benefit should be critically balanced against the considerably greater soft tissue damage caused by the fibula osteotomy. The lateral femoral epicondyle osteotomy including the LCL and PLT increases lateral articular visualization without risk to neurovascular or posterolateral soft tissue structures and represents an important extended approach to treat comminuted lateral plateau fractures.

Improved Visualization by Central Subluxation of the Lateral Meniscus in Comminuted Lateral Tibial Plateau Fractures

2020 ◽  
Author(s):  
Matthias Krause ◽  
Dario Guttowski ◽  
Klaus Püschel ◽  
Jan Philipp Kolb ◽  
Maximilian Hartel ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Articular Surface ◽  
Lateral Meniscus ◽  
Lateral Approach ◽  
Tibial Plateau Fractures ◽  
Surgical Reconstruction ◽  
Joint Surface ◽  
Anatomical Reconstruction ◽  
Lateral Plateau ◽  
Extended Lateral Approach

AbstractThe goal of surgical reconstruction of comminuted tibial plateau fractures is an anatomical reconstruction and stable fixation of the articular surface. This can be difficult due to poor visualization of the posterolateral and central segments of the articular surface of the proximal tibia. To improve visualization, the lateral approach can be extended with an osteotomy of the femoral epicondyle. In most cases, use of the extended lateral approach allows the whole lateral plateau to be visualized. Nevertheless, in some cases, an osteotomy alone is not enough to expose the entire fracture, especially the central segments of the tibial plateau. For these specific cases, we developed an additional technical trick that significantly improves articular visualization; the lateral meniscocapsular fibers are dissected allowing for central subluxation of the lateral meniscus, while leaving the anterior and posterior roots intact. With central subluxation of the lateral meniscus in comminuted tibial plateau fractures, the joint surface can be completely visualized, allowing an anatomical reduction even in highly complex fractures.

scholarly journals First clinical results after lateral epicodyle osteotomy and meniscus subluxation in the repair of tibial plateau fractures

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0052
Author(s):  
Alexander Korthaus ◽  
Tobias Malte Ballhause ◽  
Jan-Philipp Kolb ◽  
Matthias Krause ◽  
Karl-Heinz Frosch ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Case Series ◽  
Clinical Score ◽  
Clinical Results ◽  
Tibial Plateau Fractures ◽  
Lateral Tibial Plateau ◽  
Lateral Epicondyle ◽  
Radiological Results ◽  
Early Results ◽  
Clinical And Radiological Results

Introduction: Recently, a novel extended approach for comminuted lateral tibial plateau fractures was introduced. It includes a lateral epicondyle osteotomy and meniscus subluxation allowing for an almost complete overview of the lateral tibial plateau. First clinical results are presented. Hypotheses: We hypothesized, that a superior visualization using the novel approach in demanding cases leads to improved radiologic and clinical outcomes. Methods: A consecutive case series of ten in which the approach was used was followed prospectively. The cases were classified using the “10-segment classification” and the “AO classification”. To evaluate the clinical and radiological results, the Rasmussen score was applied. Results: Excellent to good clinical and radiological results were encountered after a median follow-up of 8,6 (IQR 4,3) months. The clinical score amounted to a median of 25 (IQR 2,8) and the radiological score a median of 17 (IQR 2,0). Conclusion: The early results after the treatment of demanding cased with a high degree of joint comminution presented are promising with excellent to good results, only. At the same time, despite an extended surgical procedure, no complications were encountered in the cohort. As suggested by the authors before, tibial plateau fractures should be managed using a stepwise approach with extension of the approach as individually required.

MR Imaging of Tibial Plateau Fractures: Evaluation of Fracture Types and Associated Soft Tissue Injuries

1997 ◽  
Vol 36 (5) ◽  
pp. 867
Author(s):  
Geon Lee ◽  
Chan Heo ◽  
Yong Jo Kim ◽  
Hyeok Po Kwon ◽  
Jung Hyeok Kwon ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Mr Imaging ◽  
Tibial Plateau ◽  
Soft Tissue Injuries ◽  
Tibial Plateau Fractures ◽  
Tissue Injuries ◽  
Fracture Types

Lateral Meniscus Height and ACL Reconstruction Failure: A Nested Case–Control Study

2021 ◽  
Author(s):  
Iskandar Tamimi ◽  
David Bautista Enrique ◽  
Motaz Alaqueel ◽  
Jimmy Tat ◽  
Almudena Pérez Lara ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Tibial Plateau ◽  
Case Control Study ◽  
Lateral Meniscus ◽  
Case Control ◽  
Lateral Tibial Plateau ◽  
Reconstruction Surgery ◽  
Meniscus Height ◽  
Nested Case Control ◽  
Control Study

AbstractPrevious work has shown that the morphology of the knee joint is associated with the risk of primary anterior cruciate ligament (ACL) injury. The objective of this study is to analyze the effect of the meniscal height, anteroposterior distance of the lateral tibial plateau, and other morphological features of the knee joint on risk of ACL reconstruction failure. A nested case–control study was conducted on patients who underwent an ACL reconstruction surgery during the period between 2008 and 2015. Cases were individuals who failed surgery during the study period. Controls were patients who underwent primary ACL reconstruction surgery successfully during the study period. They were matched by age (±2 years), gender, surgeon, and follow-up time (±1 year). A morphological analysis of the knees was then performed using the preoperative magnetic resonance imaging scans. The anteroposterior distance of the medial and lateral tibial plateaus was measured on the T2 axial cuts. The nonweightbearing maximum height of the posterior horn of both menisci was measured on the T1 sagittal scans. Measurements of the medial and lateral tibial slope and meniscal slope were then taken from the sagittal T1 scans passing through the center of the medial and lateral tibial plateau. A binary logistic regression analysis was done to calculate crude and adjusted odds ratios (ORs) estimates. Thirty-four cases who underwent ACL revision surgery were selected and were matched with 68 controls. Cases had a lower lateral meniscal height (6.39 ± 1.2 vs. 7.02 ± 0.9, p = 0.008, power = 84.4%). No differences were found between the two groups regarding the bone slope of the lateral compartment (6.19 ± 4.8 vs. 6.92 ± 5.8, p = 0.552), the lateral meniscal slope (–0.28 ± 5.8 vs. –1.03 ± 4.7, p = 0.509), and the anteroposterior distance of the lateral tibial plateau (37.1 ± 5.4 vs. 35.6 ± 4, p = 0.165). In addition, no differences were found in the medial meniscus height between cases and controls (5.58 ± 1.2 vs. 5.81 ± 1.2, respectively, p = 0.394). There were also no differences between cases and controls involving the medial bone slope, medial meniscal slope, or anterior posterior distance of the medial tibial plateau. Female patients had a higher medial (4.8 degrees ± 3.2 vs. 3.3 ± 4.1, p = 0.047) and lateral (8.1 degrees ± 5.1 vs. 5.6 degrees  ± 5.6, p = 0.031) tibial bone slope, and a lower medial (5.3 mm ± 1.0 vs. 6.1 mm ± 1.2, p = 0.001) and lateral (6.6 ± 1.0 vs. 7.0 ± 1.2, p = 0.035) meniscus height, and medial (4.3 ± 0.4 vs. 4.8 ± 0.4, p =0.000) and lateral (3.3 ± 0.3 vs. 3.9 ± 0.4, p = 0.000) anteroposterior distance than males, respectively.The adjusted OR of suffering an ACL reconstruction failure compared to controls was 5.1 (95% confidence interval [CI]: 1.7–14.9, p = 0.003) for patients who had a lateral meniscus height under 6.0 mm. The adjusted OR of suffering an ACL reconstruction failure was 2.4 (95% CI: 1.0–7.7, p = 0.01) for patients who had an anteroposterior distance above 35.0 mm. Patients with a lateral meniscal height under 6.0 mm have a 5.1-fold risk of suffering an ACL reconstruction failure compared to individuals who have a lateral meniscal height above 6.0 mm. Patients with a higher anteroposterior distance of the lateral tibial plateau also have a higher risk of ACL reconstruction failure.

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