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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
Few studies have shown the correlation of traumatic meniscal lesion (TML) diagnosed via arthroscopy and acute tibial plateau fracture according to well-accepted single and bilateral classification.
Research motivation
How to predict TML by three-dimensional skeletal anatomy changes in unilateral tibial plateau fractures (TPFs) and bilateral TPFs without magnetic resonance imaging or arthroscopy? Should surgery be done by optimal, open reduction, minimally invasive incision or via arthroscope?
Research objectives
We performed a retrospective study of patients diagnosed with acute fracture of tibial plateau who underwent arthroscopic surgery.
Research methods
In this retrospective case series, the type, zone, and location of TMLs were diagnosed based on the operation records and/or arthroscopic videos. Measurement of three-dimensional fracture morphology was performed on preoperative computed tomography (CT) three-dimensional plane. The correlation of TML with skeletal values was calculated according to unicondylar TPFs and bicondylar TPFs.
Research results
In this study, a total of 30 patients had TMLs, lateral/medial (23/7). The incidence of TMLs was not related to TPF type. Fragment subsiding distance (FSD) was a particularly positive factor to predict TML, OR = 2.31 (1.26-5.63) for each TPF type. On coronal view, once fragment width of plateau surpassed 3 cm, incidence of TML reached 100%; 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 transverse view, ARFA as enhanced risk of 5.5% and FSD > 4.3 mm for predicting TML were observed in unicondylar TPFs.
Research conclusions
TML can be predicted by different parameters on preoperative three dimensional CT views (frontal, sagittal, and axial planes) according to unicondylar TPFs and bicondylar TPFs. Plateau subsiding distance measured on sagittal CT images portends a higher stake of meniscus tear associated with each group TPFs.
Research perspectives
Arthroscopy is still the gold standard for diagnosing meniscus injuries and is suitable for all types of TPFs. According to the research, further in-depth research requires a multi-center study with larger sample for each type of TPF.
