Prediction of Concomitant Lateral Meniscus Injury with a Tibia Plateau Fracture Based on Computed Tomography Assessment

Wonchul Choi; Yunseong Choi; Go-Tak Kim

doi:10.12671/jkfs.2018.31.4.132

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Choi, Choi, and Kim: Prediction of Concomitant Lateral Meniscus Injury with a Tibia Plateau Fracture Based on Computed Tomography Assessment

Original Article

J Korean Fract Soc 2018;31(4):132-138.

Published online: 10 October 2018

DOI: https://doi.org/10.12671/jkfs.2018.31.4.132

Prediction of Concomitant Lateral Meniscus Injury with a Tibia Plateau Fracture Based on Computed Tomography Assessment

Wonchul Choi, M.D., Ph.D., Yunseong Choi, M.D., Go-Tak Kim, M.D.

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

Correspondence to: Wonchul Choi, M.D., Ph.D. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea Tel: +82-31-780-5289 Fax: +82-31-708-3578 E-mail: wcosdoc@gmail.com

Received 8 July 2018 Revised 10 July 2018 Accepted 23 July 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study examined whether any fracture pattern shown in computed tomography (CT) scan is associated with the presence of lateral meniscus (LM) injury in a tibia plateau fracture.

Materials and Methods

Fifty-three tibia plateau fractures with both preoperative CT and magnetic resonance imagings (MRI) available were reviewed. The patient demographics, including age, sex, body mass index, and energy level of injury were recorded. The fracture type according to the Schatzker classification, patterns including the lateral plateau depression (LPD), lateral plateau widening (LPW), fracture fragment location, and the number of columns involved were assessed from the CT scans. The presence of a LM injury was determined from the MRI. The differences in the factors between the patients with (Group 1) and without (Group 2) LM injuries were compared and the correlation between the factors and the presence of LM injury was analyzed.

Results

The LM was injured in 23 cases (Group 1, 43.4%) and intact in 30 cases (Group 2, 56.6%). The LPD in Group 1 (average, 8.2 mm; range, 3.0–20.0 mm) and Group 2 (average, 3.8 mm; range, 1.4–12.1 mm) was significantly different (p<0.001). The difference in LPW of Group 1 (average, 6.9 mm; range, 1.2–15.3 mm) and Group 2 (average, 4.8 mm; range, 1.4–9.4 mm) was not significant (p=0.097). The other fracture patterns or demographics were similar between in the two groups. Regression analysis revealed that an increased LPD (p=0.003, odds ratio [OR]=2.12) and LPW (p=0.048, OR=1.23) were significantly related to the presence of a LM tear.

Conclusion

LPD and LPW measured from the CT scans were associated with an increased risk of concomitant LM injury in tibia plateau fractures. If such fracture patterns exist, concomitant LM injury should be considered and an MRI may be beneficial for an accurate diagnosis and effective treatment.

Keywords: Tibia, Lateral meniscus, Tibia plateau fracture, Computed tomography, Magnetic resonance image, Schatzker classification

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Fig. 1.

Lateral plateau depression (LPD) and lateral plateau widening (LPW) measurements from a coronal reformatted computed tomography imaging. LPD was defined as the perpendicular distance ‘A’ between a tangential line to the neutral plane of the articular surface and a tangential line to the lowest point of depression. LPW was defined as the perpendicular distance ‘B’ between a tangential line to the lateral femoral epicondyle and a parallel line drawn from the most lateral part of the lateral tibial plateau.

Fig. 2.

A 52-year-old man presented with a Schatzker type II tibia plateau fracture of the left knee. (A) Computed tomography coronal reformatted imaging demonstrated 7.52 mm of lateral plateau depression and 4.44 mm of lateral plateau widening. (B) Meniscocapsular separation and central migration of lateral meniscus (white arrow) was shown in the coronal magnetic resonance imaging. (C) Lateral meniscus injury was confirmed during arthroscopy. (D) The lateral meniscus was repaired to the capsule using the inside-out repair technique.

Table 1.

Demographic and Clinical Characteristics of the Patients

Characteristic	Group 1 (Injured LM)	Group 2 (Intact LM)	p-value
Subject	23	30
Demographic
Age (yr)	46.7±11.3 (29–60)	42.1±10.1 (34–60)	0.874
Sex (%)			0.753
Male	18 (78.3)	24 (80.0)
Female	5 (21.7)	6 (20.0)
Body mass index (kg/m²)	25.5±3.0 (19.3–31.5)	23.9±2.9 (18.1–29.4)	0.889
Clinical
Energy level of injury			0.392
Low	9 (39.1)	9 (30.0)
High	14 (60.9)	21 (70.0)
Schatzker classification			0.286
Type I	0	1 (3.3)
Type II	8 (34.8)	13 (43.3)
Type III	3 (13.0)	3 (10.0)
Type V	9 (39.1)	8 (26.7)
Type VI	3 (13.0)	5 (16.7)
LPD (mm)	8.2±9.7 (3.0–20.0)	3.8±6.6 (1.4–12.1)	<0.001
LPW (mm)	6.9±9.4 (1.2–15.3)	4.8±5.1 (1.4–9.0)	0.097

Values are presented as number only, mean±standard deviation, or number (%). LM: lateral meniscus, LPD: lateral plateau depression, LPW: lateral plateau widening.

Table 2.

Result of Linear Regression Analysis

Covariate	Correlation coefficient	p-value	Odds ratio
Age	−0.046	0.850	0.99
Sex (male=0, female=1)	−0.113	0.732	0.97
Body mass index	0.122	0.837	1.06
Energy level of injury (low=0, high=1)	0.121	0.184	1.14
Schatzker type	1.262	0.834	0.71
Column involvement (uni=0, multi=1)	0.082	0.752	1.18
Lateral plateau depression	0.250	0.003^*	2.12
Lateral plateau widening	0.074	0.048^*	1.23

^* p<0.05.

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