scholarly journals Correlation between CT images of lateral plateau and lateral meniscus injuries in patients with Schatzker II tibial plateau fractures:a retrospective study

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Ying Pu ◽  
Zhu Lei ◽  
Ding Wenge ◽  
Xu Yue ◽  
Jiang Xiaowei ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Arthroscopic Surgery ◽  
Intraclass Correlation ◽  
Lateral Meniscus ◽  
Ct Images ◽  
Posterior Horn ◽  
Meniscus Injury ◽  
Significant Difference ◽  
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 (TPFs) 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 TPFs. Methods A total of 296 patients with Schatzker II TPFs 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. The values of both lateral plateau depression (LPD) and lateral plateau widening (LPW) of lateral tibial plateau on CT images were measured, and their correlation with lateral meniscus injury was then analyzed. The relevant receiver operating characteristic (ROC) curve was drawn to evaluate the optimal cut-off point of the two indicators which could predict meniscus injury. Results The intra- and inter-observer reliabilities of LPD and LPW were acceptable (intraclass correlation coefficient (ICC) > 0.8). 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 between the two groups was statistically significant (P < 0.05). The average LPW was 8.0 ± 1.4 mm and 6.8 ± 1.6 mm in meniscus injury and non-meniscus injury groups with a significant difference (P < 0.05). The optimal predictive cut-off value 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. The meniscus injury group mainly showed injuries involving the mid-body and posterior horn of lateral meniscus (98.1%, 157/160). Conclusions The mid-body and posterior horn of lateral meniscus injury is more likely to occur in patients with Schatzker II TPFs when LPD > 7.9 mm and/or LPW > 7.5 mm on CT. These findings will definitely provide guidance for orthopedic surgeons in treating such injuries. During the operation, more attention is required be paid to the treatment of the meniscus and the possible fracture reduction difficulties and poor alignment caused by meniscus rupture and incarceration should be fully considered in order to achieve better surgical results.

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 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.

scholarly journals DEFINING A SAFE ZONE FOR ALL INSIDE LATERAL MENISCUS REPAIRS IN PEDIATRIC PATIENTS: A MAGNETIC RESONANCE IMAGING STUDY

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0017
Author(s):  
Jennifer Beck ◽  
Kendall Shifflett ◽  
Danielle Greg ◽  
Edward Ebramzadeh ◽  
Richard E. Bowen
Keyword(s):  
Pediatric Patients ◽  
Age Groups ◽  
Lateral Meniscus ◽  
Safe Zone ◽  
Neurovascular Bundle ◽  
Posterior Horn ◽  
Popliteus Tendon ◽  
Anterior Edge ◽  
Group I ◽  
Significant Difference

Purpose All-inside posterior horn lateral meniscal (PHLM) repair puts the popliteal neurovascular bundle (PVNB) at risk of injury by meniscal repair devices. The purpose of this study was to establish a safe zone of all-inside meniscal fixation in pediatric patients using MRI measurements between the popliteus tendon (PT) and popliteal neurovascular bundle (PNVB). We hypothesize that males and older age groups will have a larger distance between PT and PNVB. Methods Axial MRIs of 250 pediatric (5-16 yrs.) patients were retrospectively reviewed. Patients were grouped by age: group I (5-7yrs.): 61; II (8-10yrs.): 59; III (11-13yrs.): 60; IV (14-16yrs.): 70. At the level of the lateral meniscus, two lines starting at the lateral patella tendon border ending at the medial edge of the PT (D1) and the lateral edge of the PNVB (D2) were made on an axial knee MRI. D3 connected D1 to D2 at the meniscocapsular junction of the PHLM. D4 was derived geometrically, parallel and 8 mm anterior to D3 simulating the anterior edge of the PHLM. Results Analysis showed significant correlation between age and sex for D3 (p<0.0001). For D3, there were significant differences among all age groups, except between groups III and IV. Average (STD) D3 for age groups was: 14.1mm(3.1), 15.8(2.5), 17.0(3.3), 17.2(3.1). For D4, the average (STD) was: 11.9 mm(2.9); 13.9(2.5); 15.4(3.0); 15.2(2.9). There was significant difference in D3 and D4 in males versus females (17.6 vs 15.7 mm; p <0.001; 14.9 vs 13.2; p <0.001), particularly in III and IV (17.0 vs 13.8 and 16.8 vs 13.9). Conclusions This study provides normative data of the distance between popliteal neurovascular bundle and popliteus tendon at the meniscocapsular junction (D3) and anterior edge of the posterior horn lateral meniscus (D4) with the knee in full extension. Combined with previous studies showing the addition of knee flexion increases the distance between the meniscus and the neurovascular bundle, surgeons can use this data to improve safety of posterior horn lateral meniscus repair in pediatric patients.

scholarly journals Evaluation of the Usefulness of CO-RADS for Chest CT in Patients Suspected of Having COVID-19

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 608 ◽  
Author(s):  
Tomoyuki Fujioka ◽  
Marie Takahashi ◽  
Mio Mori ◽  
Junichi Tsuchiya ◽  
Emi Yamaga ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Characteristic Curve ◽  
Intraclass Correlation ◽  
Ct Images ◽  
Chest Ct ◽  
Rt Pcr ◽  
Radiological Society ◽  
Significant Difference ◽  
The Individual ◽  
Sensitivity Specificity

The purpose of this study was to use the Coronavirus Disease 2019 (COVID-19) Reporting and Data System (CO-RADS) to evaluate the chest computed tomography (CT) images of patients suspected of having COVID-19, and to investigate its diagnostic performance and interobserver agreement. The Dutch Radiological Society developed CO-RADS as a diagnostic indicator for assessing suspicion of lung involvement of COVID-19 on a scale of 1 (very low) to 5 (very high). We investigated retrospectively 154 adult patients with clinically suspected COVID-19, between April and June 2020, who underwent chest CT and reverse transcription-polymerase chain reaction (RT-PCR). The patients’ average age was 61.3 years (range, 21–93), 101 were male, and 76 were RT-PCR positive. Using CO-RADS, four radiologists evaluated the chest CT images. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. Interobserver agreement was calculated using the intraclass correlation coefficient (ICC) by comparing the individual reader’s score to the median of the remaining three radiologists. The average sensitivity was 87.8% (range, 80.2–93.4%), specificity was 66.4% (range, 51.3–84.5%), and AUC was 0.859 (range, 0.847–0.881); there was no significant difference between the readers (p > 0.200). In 325 (52.8%) of 616 observations, there was absolute agreement among observers. The average ICC of readers was 0.840 (range, 0.800–0.874; p < 0.001). CO-RADS is a categorical taxonomic evaluation scheme for COVID-19 pneumonia, using chest CT images, that provides outstanding performance and from substantial to almost perfect interobserver agreement for predicting COVID-19.

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 Correlation of Biomechanical Alterations under Gonarthritis between Overlying Menisci and Articular Cartilage

2020 ◽  
Vol 10 (23) ◽  
pp. 8673 ◽  
Author(s):  
Johannes Pordzik ◽  
Anke Bernstein ◽  
Julius Watrinet ◽  
Hermann O. Mayr ◽  
Sergio H. Latorre ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Applied Load ◽  
Structural Changes ◽  
Tibial Plateau ◽  
Biomechanical Properties ◽  
Posterior Horn ◽  
Joint Surfaces ◽  
Significant Difference ◽  
Instantaneous Modulus ◽  
Biomechanical Changes

Just like menisci, articular cartilage is exposed to constant and varying stresses. Injuries to the meniscus are associated with the development of gonarthritis. Both the articular cartilage and the menisci are subject to structural changes under gonarthritis. The aim of this study was to investigate biomechanical alterations in articular cartilage and the menisci under gonarthritis by applying an indentation method. The study assessed 11 menisci from body donors as controls and 21 menisci from patients with severe gonarthritis. For the simultaneous examination of the articular cartilage and the menisci, we only tested the joint surfaces of the tibial plateau covered by the corresponding menisci. Over the posterior horn of the meniscus, the maximum applied load—the highest load registered by the load cell—of the arthritic samples of 0.02 ± 0.02 N was significantly greater (p = 0.04) than the maximum applied load of the arthritis-free samples of 0.01 ± 0.01 N. The instantaneous modulus (IM) at the center of the arthritic cartilage covered by the meniscus with 3.5 ± 2.02 MPa was significantly smaller than the IM of the arthritis-free samples with 5.17 ± 1.88 MPa (p = 0.04). No significant difference was found in the thickness of the meniscus-covered articular cartilage between the arthritic and arthritis-free samples. Significant correlations between the articular cartilage and the corresponding menisci were not observed at any point. In this study, the biomechanical changes associated with gonarthritis affected the posterior horn of the meniscus and the mid region of the meniscus-covered articular cartilage. The assessment of cartilage thickness as a structural characteristic of osteoarthritis may be misleading with regard to the interpretation of articular cartilage’s biomechanical properties.

scholarly journals Image Patch-Based Net Water Uptake and Radiomics Models Predict Malignant Cerebral Edema After Ischemic Stroke

2020 ◽  
Vol 11 ◽  
Author(s):  
Bowen Fu ◽  
Shouliang Qi ◽  
Lin Tao ◽  
Haibin Xu ◽  
Yan Kang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Water Uptake ◽  
Cerebral Edema ◽  
Intraclass Correlation ◽  
Ct Images ◽  
Imaging Features ◽  
Lesion Segmentation ◽  
Image Patch ◽  
Ischemic Lesion ◽  
Significant Difference

Malignant cerebral edema (MCE) after an ischemic stroke results in a poor outcome or death. Early prediction of MCE helps to identify subjects that could benefit from a surgical decompressive craniectomy. Net water uptake (NWU) in an ischemic lesion is a predictor of MCE; however, CT perfusion and lesion segmentation are required. This paper proposes a new Image Patch-based Net Water Uptake (IP-NWU) procedure that only uses non-enhanced admission CT and does not need lesion segmentation. IP-NWU is calculated by comparing the density of ischemic and contralateral normal patches selected from the middle cerebral artery (MCA) area using standard reference images. We also compared IP-NWU with the Segmented Region-based NWU (SR-NWU) procedure in which segmented ischemic regions from follow-up CT images are overlaid onto admission images. Furthermore, IP-NWU and its combination with imaging features are used to construct predictive models of MCE with a radiomics approach. In total, 116 patients with an MCA infarction (39 with MCE and 77 without MCE) were included in the study. IP-NWU was significantly higher for patients with MCE than those without MCE (p &lt; 0.05). IP-NWU can predict MCE with an AUC of 0.86. There was no significant difference between IP-NWU and SR-NWU, nor between their predictive efficacy for MCE. The inter-reader and interoperation agreement of IP-NWU was exceptional according to the Intraclass Correlation Coefficient (ICC) analysis (inter-reader: ICC = 0.92; interoperation: ICC = 0.95). By combining IP-NWU with imaging features through a random forest classifier, the radiomics model achieved the highest AUC (0.96). In summary, IP-NWU and radiomics models that combine IP-NWU with imaging features can precisely predict MCE using only admission non-enhanced CT images scanned within 24 h from onset.

scholarly journals Effect of arthroscopic surgery combined with platelet-rich plasma in the treatment of discoid meniscus injury of knee joint and its influence on serum inflammatory factors

2019 ◽  
Vol 17 ◽  
pp. 205873921881433
Author(s):  
Jia Liu
Keyword(s):  
Knee Joint ◽  
Platelet Rich Plasma ◽  
Arthroscopic Surgery ◽  
Inflammatory Factors ◽  
Control Group ◽  
Study Group ◽  
Discoid Meniscus ◽  
Meniscus Injury ◽  
Tnf Α ◽  
Significant Difference

This study was to observe the effect of arthroscopic surgery combined with platelet-rich plasma (PRP) in the treatment of discoid meniscus injury of knee joint and its influence on serum inflammatory factors. A total of 80 patients with discoid meniscus injury in our hospital from June 2014 to June 2016 were enrolled and divided into study group and control group randomly with 40 patients in each group. The control group was treated with arthroscopy alone, and the study group was treated with arthroscopy combined with PRP. The clinical efficacy of the two groups was observed, and the Lysholm scores, Knee injury and Osteoarthritis Outcome Score (KOOS scores), and serum inflammatory factors (IL-1, TNF-α, and IL-6) were compared between the two groups before and after treatment. Six months after the treatment, the improvement rate, defined as (Excellent + Good)/total*100, of the study group was 97.5%, significantly higher than that of the control group, which was 87.5% ( P < 0.05); before treatment, there was no significant difference in both Lysholm scores and KOOS scores between the two groups ( P > 0.05); and 6 months later, the Lysholm scores and KOOS scores in the two groups were both significantly higher than those before, and the scores in the study group increased more significantly compared with those of the control group ( P < 0.05); the values of serum IL-1, TNF-α, and IL-6 in the two groups were both significantly lower than those before, and the values in the study group decreased more significantly compared with those of the control group ( P < 0.05). In conclusion, arthroscopic surgery combined with PRP therapy can effectively improve the clinical symptoms and reduce the level of serum inflammatory factors in patients with discoid meniscus injury of the knee, which is worthy of promotion and application.

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.

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