Department of Orthopedic Surgery, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul, South Korea.
Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, 21, Bonghyeon-ro, Jinjeop-eup, Namyangju-si, Gyeonggi-do, 12013, South Korea.
Arch Orthop Trauma Surg. 2022 Feb;142(2):263-270. doi: 10.1007/s00402-021-03825-z. Epub 2021 Mar 15.
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.
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.
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.
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.
Level IV retrospective cohort study.
评估 AR/IF 和半月板修复治疗外侧半月板（LM）撕裂合并外侧胫骨平台骨折的临床和影像学结果，并确定与 LM 撕裂相关的因素。
回顾性纳入 42 例接受 AR/IF 治疗的外侧平台骨折（Schatzker Ⅱ型和Ⅲ型）患者。采用 Rasmussen 系统和计算机断层扫描（CT）进行影像学评估。末次随访时进行临床评估。金属取出时行二次关节镜检查。
所有骨折均在随访 46.3 个月后愈合。Tegner 活动水平从受伤前的 7.1±2.1 分无明显下降，至末次随访时为 6.6±2.3 分（p=0.301）。然而，CT 成像上的凹陷程度从 8.9±4.4mm 显著下降至 1.2±1.3mm（p=0.000）。末次随访时平均 Rasmussen 影像学评分 14.5±5.3 分。6 例（14.3%）发生进展性骨关节炎。25 例患者合并 LM 撕裂，18 例接受修复治疗，其余接受半月板部分切除术。术前关节凹陷（>11mm）与 LM 撕裂风险显著相关（p=0.024；比值比（OR）：9.0，95%置信区间（CI）：1.018-79.545），且大部分病变可修复（p=0.001）。术后 16 例修复患者行二次关节镜检查，15 例完全愈合，1 例部分愈合。
LM 撕裂常合并外侧胫骨平台骨折，尤其是与关节凹陷>11mm 相关，但大多数病变可在骨折固定时修复。AR/IF 联合关节镜半月板修复治疗 Schatzker Ⅱ型和Ⅲ型胫骨平台骨折可获得良好的临床和影像学结果。
IV 级回顾性队列研究。
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