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Citation
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Warner SJ, Garner MR, Schottel PC, Fabricant PD, Thacher RR, Loftus ML, Helfet DL, Lorich DG. J. Orthop. Trauma 2018; 32(3): 141-147. |
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Affiliation
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1Orthopaedic Trauma Service Hospital for Special Surgery New York, NY 2Orthopaedic Trauma Service Pennsylvania State University Seattle, WA 3Orthopaedic Trauma Service University of Vermont Medical Center Burlington, VT 4Pediatric Orthopaedic Service Hospital for Special Surgery New York, NY 5Orthopaedic Trauma Service Hospital for Special Surgery New York, NY 6Department of Clinical Radiology Weill Cornell Medical College, New York Presbyterian Hospital New York, NY 7Director, Orthopaedic Trauma Service Hospital for Special Surgery and Weill Cornell Medical College, New York Presbyterian Hospital New York, NY 8Associate Director, Orthopaedic Trauma Service Hospital for Special Surgery and Weill Cornell Medical College, New York Presbyterian Hospital New York, NY. |
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Abstract
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OBJECTIVE: The purpose of this study was to determine if ligamentous and meniscal injuries as determined by initial magnetic resonance imaging altered clinical outcomes following the fixation of tibial plateau fractures.
DESIGN: Comparative cohort study. SETTING: Academic level I trauma center. PATIENTS/PARTICIPANTS: Eighty-two patients from a prospective database of operatively treated tibial plateau fractures met the inclusion criteria, which consisted of injury radiographs, preoperative knee MRI, and a minimum of twelve months of clinical outcomes. INTERVENTION: In addition to radiographs and CT scans for fracture assessment, an MRI was performed to detect tears in the medial and lateral menisci and complete ruptures of the cruciate (ACL, PCL) and collateral (LCL, MCL) ligaments. Surgical fixation of tibial plateau fractures was performed by a single surgeon based on injury patterns. MAIN OUTCOME MEASUREMENTS: Clinical outcomes included the Knee Outcome Survey Activities of Daily Living Scale, the Lower Extremity Functional Scale, the Short-Form 36, and knee range of motion (ROM). Secondary soft tissue surgeries and conversion to arthroplasty were also noted.
RESULTS: On injury MRI, 60 patients (73%) had injuries to at least one soft tissue structure. At final follow-up, 2 patients (2%) had a secondary soft tissue surgery and 1 patient (1%) underwent total knee arthroplasty. Patient-reported outcomes and ROM assessments were not significantly different in patients with and without medial meniscal tears, lateral meniscal tears, and complete MCL ruptures.
CONCLUSIONS: In this cohort of patients with operative tibial plateau fractures, sutured lateral meniscal tears, untreated medial meniscus tears and complete MCL ruptures did not significantly affect clinical outcomes. In addition, these data suggest that obtaining a preoperative MRI in patients with tibial plateau fractures to diagnose soft tissue injuries may not alter the surgical treatment or alter patient prognosis for mid-term outcomes. LEVEL OF EVIDENCE: Level III, Prognostic Retrospective Cohort Study.
Language: en |