Stephens Alastair, Searle Henry, Carlos William, Gomindes Austin, Pilarski Adam, Syed Farhan, Smith Nicholas, Khatri Chetan
University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.
University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.
Injury. 2024 Jun;55(6):111546. doi: 10.1016/j.injury.2024.111546. Epub 2024 Apr 3.
Currently there is no consensus on the need for investigating knee ligamentous and meniscal injuries in a patient with a tibial plateau fracture. Consequently, many soft tissue injuries are likely undiagnosed and therefore untreated. The impact this has on long term knee outcomes is not well defined. We aimed to identify the impacts of various diagnostic methods on the management of meniscal injuries associated with tibial plateau fractures and evaluate the clinical outcomes.
We performed a systematic review using Pubmed, Medline, Embase, CINAHL and Cochrane following Cochrane guidelines. We included studies that operatively managed tibial plateau fractures and soft tissue injuries, which were diagnosed with either preoperative MRI, intra-operative arthroscopy or arthrotomy.
18 articles with 884 people, with a mean age of 46.4 years were included. Soft tissue injuries were detected on MRI (32-73%) and arthroscopy (12-70%), of which the most common were lateral meniscal injuries (7-64% of tibial plateau fractures). When identified by arthroscopy and arthrotomy, these injuries were almost always treated, either by repair or debridement. The clinical outcomes of these patients were poorly reported, with a heterogenous use of patient reported outcome measures, and follow up time points. There were no randomised trials or control groups for comparative analysis, however operative treatment yielded good to excellent outcomes.
There is a high incidence of concomitant soft tissue injuries with tibial plateau fractures, particularly lateral meniscal injuries. There are 2 main approaches to meniscal injuries: surgeons who don't investigate, don't treat, whilst surgeons who do investigate often do surgically treat. Although studies that treated these injuries achieved good to excellent results, the currently available evidence doesn't confirm treatment superiority. As there is plausibility for better outcomes, randomised studies are needed to further investigate this clinical question.
目前，对于胫骨平台骨折患者是否需要检查膝关节韧带和半月板损伤尚无共识。因此，许多软组织损伤可能未被诊断出来，进而未得到治疗。其对膝关节长期预后的影响尚不明确。我们旨在确定各种诊断方法对与胫骨平台骨折相关的半月板损伤治疗的影响，并评估临床疗效。
我们按照Cochrane指南，使用PubMed、Medline、Embase、CINAHL和Cochrane进行了系统评价。我们纳入了对胫骨平台骨折和软组织损伤进行手术治疗的研究，这些损伤通过术前MRI、术中关节镜检查或切开术进行诊断。
纳入了18篇文章，共884人，平均年龄46.4岁。MRI（32 - 73%）和关节镜检查（12 - 70%）发现了软组织损伤，其中最常见的是外侧半月板损伤（占胫骨平台骨折的7 - 64%）。通过关节镜检查和切开术发现这些损伤后，几乎总是进行治疗，要么修复要么清创。这些患者的临床疗效报告不佳，患者报告结局指标的使用存在异质性，且随访时间点也不一致。没有随机试验或对照组进行比较分析，然而手术治疗取得了良好至优异的疗效。
胫骨平台骨折合并软组织损伤的发生率很高，尤其是外侧半月板损伤。对于半月板损伤有两种主要处理方式：不进行检查的外科医生不治疗，而进行检查的外科医生通常会进行手术治疗。尽管治疗这些损伤的研究取得了良好至优异的结果，但现有证据并未证实治疗的优越性。由于有理由期待更好的疗效，因此需要进行随机研究以进一步探讨这个临床问题。
