Operatively Treated Meniscal Tears Associated With Tibial Plateau Fractures: A Report on 661 Patients.

OBJECTIVE

To describe the incidence and common patterns of lateral meniscal tears detected intraoperatively and surgically treated based on tibial plateau fracture patterns.

DESIGN

Retrospective analysis of a prospective database.

SETTING

Level One Regional Trauma Center.

METHODS

All tibial plateau fractures in skeletally mature patients treated operatively between 2002 and 2011 were included. All operative notes and radiographs were reviewed to determine type of tibial plateau fracture, mechanism of injury, intraoperative detection of a lateral meniscal tear, and operative repair/partial resection of the meniscus itself. Patients were excluded if there was no mention of a submeniscal arthrotomy, if fracture stabilization was performed percutaneously, or if the fracture was an isolated medial condyle fracture. Statistical analysis was performed using χ analysis and Fisher exact test to determine the overall incidence of lateral meniscal tears and any correlation between meniscal tear and fracture pattern.

RESULTS

A total of 602 patients were included in the final analysis. Lateral meniscal tears requiring operative repair were detected intraoperatively in 179 patients (30%). This could be broken down into 12% for pure lateral split fractures, 45% for split depression fractures (P < 0.001), 18% for pure depression fractures, 22% for bicondylar fractures, and 26% for intraarticular plus shaft fractures. Lateral meniscal tears associated with a split depression fracture pattern were most commonly peripheral rim tears (83%). For all other fracture patterns, the type of meniscal injury was evenly distributed between peripheral and radial tear. Young males demonstrated a statistically higher rate of lateral meniscal tears (33%).

CONCLUSIONS

In our series, the incidence of a lateral meniscal tear detected intraoperatively requiring repair was 30%. These tears occurred more frequently in young males, with peripheral rim tears most commonly associated with split depression fractures. Based on our data, we believe that preoperative imaging for meniscal injury overstates the true incidence of meniscal tears requiring operative intervention.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.