Orthopaedic Trauma Service, University of Texas Health Science Center at Houston, Houston, TX.
Orthopaedic Trauma Service, Penn State Milton D. Hershey Medical Center, Hershey, PA.
J Orthop Trauma. 2018 Mar;32(3):141-147. doi: 10.1097/BOT.0000000000001042.
To determine if ligamentous and meniscal injuries as determined by initial magnetic resonance imaging altered clinical outcomes after the fixation of tibial plateau fractures.
Comparative cohort study.
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 magnetic resonance imaging (MRI), and a minimum of 12 months of clinical outcomes.
In addition to radiographs and computed tomography scans for fracture assessment, an MRI was performed to detect tears in the medial and lateral menisci and complete ruptures of the cruciate ligaments (anterior cruciate ligament and posterior cruciate ligament) and collateral ligaments [lateral collateral ligament and medial collateral ligament (MCL)]. Surgical fixation of tibial plateau fractures was performed by a single surgeon based on injury patterns.
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. Secondary soft tissue surgeries and conversion to arthroplasty were also noted.
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 range of motion assessments were not significantly different in patients with and without medial meniscal tears, lateral meniscal tears, and complete MCL ruptures.
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 midterm outcomes.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定初始磁共振成像（MRI）确定的韧带和半月板损伤是否改变了胫骨平台骨折固定后的临床结果。
比较队列研究。
学术水平 I 级创伤中心。
患者/参与者：从手术治疗的胫骨平台骨折的前瞻性数据库中，82 名患者符合纳入标准，这些标准包括损伤 X 线片、术前膝关节 MRI 以及至少 12 个月的临床结果。
除了骨折评估的 X 线片和计算机断层扫描外，还进行了 MRI 以检测内侧和外侧半月板以及前交叉韧带和后交叉韧带（前交叉韧带和后交叉韧带）和侧副韧带（外侧副韧带和内侧副韧带（MCL））的完全撕裂。根据损伤模式，由一名外科医生对胫骨平台骨折进行手术固定。
临床结果包括膝关节结果调查日常生活量表、下肢功能量表、简明健康调查量表和膝关节活动范围。还注意到继发性软组织手术和关节置换转换。
在损伤 MRI 上，60 名患者（73%）至少有一个软组织结构损伤。在最终随访时，2 名患者（2%）进行了二次软组织手术，1 名患者（1%）接受了全膝关节置换术。内侧半月板撕裂、外侧半月板撕裂和完全 MCL 撕裂患者的患者报告结果和膝关节活动范围评估无显著差异。
在本队列研究中，接受手术治疗的胫骨平台骨折患者中，缝合的外侧半月板撕裂、未治疗的内侧半月板撕裂和完全 MCL 撕裂并未显著影响临床结果。此外，这些数据表明，在胫骨平台骨折患者中获得术前 MRI 以诊断软组织损伤可能不会改变手术治疗或改变患者的中期预后。
预后 III 级。有关证据水平的完整描述，请参见作者说明。
