Stahl Daniel, Serrano-Riera Rafael, Collin Kristopher, Griffing Rebecca, Defenbaugh Bradley, Sagi H Claude
*Scott and White Hospital, Temple, TX; †Florida Orthopaedic Institute, Tampa, FL; and ‡University of South Florida, Tampa, FL.
J Orthop Trauma. 2015 Jul;29(7):322-4. doi: 10.1097/BOT.0000000000000290.
To describe the incidence and common patterns of lateral meniscal tears detected intraoperatively and surgically treated based on tibial plateau fracture patterns.
Retrospective analysis of a prospective database.
Level One Regional Trauma Center.
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.
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%).
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.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
描述术中检测到并根据胫骨平台骨折类型进行手术治疗的外侧半月板撕裂的发生率及常见模式。
对前瞻性数据库进行回顾性分析。
一级区域创伤中心。
纳入2002年至2011年间接受手术治疗的骨骼成熟患者的所有胫骨平台骨折病例。查阅所有手术记录和X线片，以确定胫骨平台骨折类型、损伤机制、术中外侧半月板撕裂的检测情况以及半月板本身的手术修复/部分切除术。若未提及半月板下关节切开术、经皮进行骨折固定或骨折为孤立的内侧髁骨折，则将患者排除。采用χ分析和Fisher精确检验进行统计分析，以确定外侧半月板撕裂的总体发生率以及半月板撕裂与骨折类型之间的相关性。
最终分析共纳入602例患者。术中检测到需要手术修复的外侧半月板撕裂患者有179例（30%）。其中单纯外侧劈裂骨折患者占12%，劈裂凹陷骨折患者占45%（P<0.001），单纯凹陷骨折患者占18%，双髁骨折患者占22%，关节内加骨干骨折患者占26%。与劈裂凹陷骨折类型相关的外侧半月板撕裂最常见的是周边缘撕裂（83%）。对于所有其他骨折类型，半月板损伤类型在周边撕裂和放射状撕裂之间均匀分布。年轻男性外侧半月板撕裂的发生率在统计学上更高（33%）。
在我们的系列研究中，术中检测到需要修复的外侧半月板撕裂的发生率为30%。这些撕裂在年轻男性中更常见，周边缘撕裂最常与劈裂凹陷骨折相关。根据我们的数据，我们认为术前半月板损伤的影像学检查高估了需要手术干预的半月板撕裂的真实发生率。
预后IV级。有关证据水平的完整描述，请参阅作者指南。
