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Clinical and radiographic results after arthroscopic repair of lateral meniscus tear in lateral-depression tibial plateau fracture

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

To evaluate the clinical and radiographic results of AR/IF and meniscus repair for treating lateral meniscus (LM) tears associated with lateral tibial plateau fractures and to identify the factors associated with LM tear.

Materials and methods

Forty-two patients with lateral plateau fractures (Schatzker types II and III) treated by AR/IF were included retrospectively. Radiographic evaluations using the Rasmussen system and computerized tomography (CT) were performed. Clinical evaluations were also conducted at final follow-up. Second-look arthroscopy was applied during metal removal.

Results

All fractures were healed after 46.3 months of follow-up. The mean Tegner activity level was not decreased significantly, going from 7.1 ± 2.1 pre-injury to 6.6 ± 2.3 at final follow-up (p = 0.301). However, the amount of depression noted on CT imaging was significantly decreased from 8.9 mm ± 4.4 to 1.2 mm ± 1.3 (p = 0.000). The mean Rasmussen radiologic score at final follow-up was 14.5 ± 5.3 points. Osteoarthritis was progressed in six patients (14.3%). Twenty-five patients had concomitant LM tear, with 18 cases treated by repair and the remaining ones treated by partial meniscectomy. Preoperative joint depression (> 11 mm) was significantly associated with the risk of LM tear (p = 0.024; odds ratio (OR): 9.0, 95% confidence interval (CI): 1.018–79.545) and most of those lesions could be repaired (p = 0.001). Postoperatively, 16 repaired patients were evaluated by second-look arthroscopy; 15 had healed completely and one had healed partially.

Conclusion

LM tears are frequently combined with lateral tibial plateau fracture, especially in correlation with more than 11 mm of joint depression, though most of those lesions can be repaired at the time of fracture fixation. AR/IF with arthroscopic meniscus repair could achieve good clinical and radiographic outcomes when treating Schatzker types II and III tibial plateau fractures.

Study design

Level IV retrospective cohort study.

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Authors and Affiliations

  1. Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul, 134-727, South Korea

    Seung Hyuk Lee, Hyungon Gwak, Kang II Kim & Sang Hak Lee

  2. Department of Orthopedic Surgery, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, South Korea

    Seong Hwan Kim

  3. Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, 21, Bonghyeon-ro, **jeop-eup, Namyangju-si, Gyeonggi-do, 12013, South Korea

    Seong Hwan Kim

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The study was approved by the Institutional Review Board (IRB No.: KHNMC 2019–08-004–001) and performed in accordance with the ethical standards of the Declaration of Helsinki 1964.

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Supplementary Information

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Supplementary file1 (MP4 23483 KB) Video 1. Demonstration of AR/IF and meniscus repair for treating LM tears associated with lateral tibial plateau fractures. Peripheral longitudinal tear of the LM anterior horn is frequently combined; thus, fracture geometry can clearly be seen through the gap of the LM anterior horn tear if it is moved to the posterior direction by probing. Under arthroscopy visualization, a tibial guide for anterior cruciate ligament reconstruction and a bone impactor were used for targeting and elevating the depressed lesions. After reduction, internal fixation with a plate and screw was performed. LM anterior horn was also repaired using a modified outside-in technique for vertical suture. In cases without LM tear, a meniscal retractor or probe can be used for anterior traction of the LM anterior horn to visualize the fractures.

402_2021_3825_MOESM2_ESM.tiff

Supplementary file2 (TIFF 35 KB) Appendix figure 1. The ROC curve of the amount of preoperative depression for the risk of concomitant LM tear.

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Kim, S.H., Lee, S.H., Gwak, H. et al. Clinical and radiographic results after arthroscopic repair of lateral meniscus tear in lateral-depression tibial plateau fracture. Arch Orthop Trauma Surg 142, 263–270 (2022). https://doi.org/10.1007/s00402-021-03825-z

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