Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2021; 9(1): 81-90
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.81
Is traumatic meniscal lesion associated with acute fracture morphology changes of tibia plateau? A series of arthroscopic analysis of 67 patients
Yan-Dong Chen, Shu-Xiang Chen, Hong-Guang Liu, Xiang-Sheng Zhao, Wen-Huan Ou, Huan-Xi Li, Hong-Xing Huang
Yan-Dong Chen, 3rd Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
Yan-Dong Chen, Shu-Xiang Chen, Hong-Guang Liu, Wen-Huan Ou, Huan-Xi Li, Department of Joint Trauma, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen 529031, Guangdong Province, China
Xiang-Sheng Zhao, Department of Radiology, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Jiangmen 529031, Guangdong Province, China
Hong-Xing Huang, Science and Education Section, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510378, Guangdong Province, China
Author contributions: Chen SX and Liu HG performed the arthroscopic evaluation and diagnosis; Chen YD acquired the measurement value and contributed to manuscript drafting; Chen YD and Zhao XS performed the radiologic diagnosis; Ou WH and Li HX were responsible for statistics; Huang HX was responsible for revising the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Supported by The Jiangmen Science and Technology Project, No. 2017A2018.
Institutional review board statement: The study was reviewed and approved by the Jiangmen Wuyi Hospital of TCM Institutional Review Board (Approval No. KY2017-8).
Conflict-of-interest statement: Yan-Dong Chen, Shu-Xiang Chen, Hong-Guang Liu, Xiang-Sheng Zhao, Wen-Huan Ou, Huan-Xi Li, Hong-Xing Huang has not received fees for serving as a speaker, and received research funding from Jiangmen Science and Technology Organization.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Xing Huang, PhD, Chief Doctor, Dean, Professor, Science and Education Section, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 261 Longxi Avenue, Liwan District, Guangzhou 510378, Guangdong Province, China. hhx@gzucm.edu.cn
Received: September 28, 2020
Peer-review started: September 28, 2020
First decision: November 3, 2020
Revised: November 10, 2020
Accepted: November 14, 2020
Article in press: November 14, 2020
Published online: January 6, 2021
Processing time: 94 Days and 21 Hours
Abstract
BACKGROUND

Computed tomography (CT) has become a routine preoperative examination for tibial plateau fractures (TPFs). Assessing the location of the fragment and intercondylar eminence fracture can provide clinicians with valuable information; however, the evaluation of traumatic meniscal lesion (TML) and arthroscopic management are controversial.

AIM

To predict TML by three-dimensional skeletal anatomy changes in unilateral TPF and bilateral TPF on preoperative thin layer CT.

METHODS

Acute fracture of tibial plateau patients undergoing arthroscopic surgery between December 2017 and December 2019 were included in this retrospective study. The type, zone, and location of TMLs were diagnosed based on the operation records and/or arthroscopic videos. Measurement of three-dimensional fracture morphology included the following: Frontal fragment width of plateau, sagittal fragment subsiding distance (FSD), sagittal fracture line distance, sagittal posterior tibial slope, and transversal area ratio of fragment area) on preoperative CT three-dimensional plane. The correlation of TML with skeletal values was calculated according to unicondylar TPFs and bicondylar TPFs.

RESULTS

A total of 67 patients were enrolled in this study, among which 30 patients had TMLs, lateral/medial (23/7). FSD was a particularly positive factor to predict TML, with odds ratio of 2.31 (1.26-5.63). On sagittal view of CT, FSD degree of 8 mm and posterior tibial slope exceeding 11.74° implied enhanced risk of TML in bicondylar TPFs. On coronal view, once fragment width of plateau surpassed 3 cm, incidence of TML reached 100%. On transverse view, area ratio of fragment as enhanced risk of 5.5% and FSD > 4.3 mm for predicting TML were observed in unicondylar TPFs.

CONCLUSION

TML can be predicted by different parameters on preoperative CT views according to unicondylar fractures and bicondylar TPFs.

Keywords: Traumatic meniscal lesion; Knee; Three-dimensional computerized tomography; Posterior tibial slope; Unicondylar fracture; Bicondylar fracture

Core Tip: On sagittal view of computerized tomography, fragment subsiding distance degree of 8 mm and posterior tibial slope exceeding 11.74° implied enhanced risk of traumatic meniscal lesion (TML) in bicondylar tibial plateau fractures. On coronal view, once fragment width of plateau surpassed 3 cm, incidence of TML reached 100%. On transverse view, area ratio of fragment area as enhanced risk of 5.5% and fragment subsiding distance > 4.3 mm for predicting TML was observed in unicondylar tibial plateau fractures.