Wang Binghao, Zhu Yi, Zhang Binbin, Wang Yukai, Yan Lifeng, Xie Xuetao, Luo Congfeng
Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Orthop J Sports Med. 2024 Apr 8;12(4):23259671241238023. doi: 10.1177/23259671241238023. eCollection 2024 Apr.
Anterior cruciate ligament (ACL) tears are commonly seen with concomitant injuries to the posterolateral tibial plateau, while the occurrence of ACL injuries in posterolateral tibial plateau fractures (PTPFs) remains unclear.
To (1) explore the incidence of knee ligament (anterior or posterior cruciate ligament, medial or lateral collateral ligament) and medial or lateral meniscus injuries in patients with PTPF and (2) find reliable PTPF-related parameters to predict the risk of knee ligament and meniscal injuries.
Cross-sectional study; Level of evidence, 3.
Patients diagnosed with PTPF who had computed tomography and magnetic resonance imaging (MRI) data were identified. Morphological parameters of the PTPF were measured on sagittal computed tomography images. Knee ligament and meniscal injuries were assessed using MRI. The association of ACL injuries with meniscal injuries was analyzed. Receiver operating characteristic (ROC) analysis was used to determine the value and cutoff point of the PTPF morphological parameters for diagnosing complete in-substance ACL tears.
Overall, 113 patients with PTPF were included. ACL injuries were present in 94 (83.2%) patients, including 43 (38.1%) avulsion fractures and 28 (24.8%) complete in-substance tears. Patients with in-substance ACL tears had a higher incidence of lateral meniscus posterior horn tears compared with the other patients ( < .001). ROC analysis revealed that both the fracture depression angle (cutoff point, 25.5°) and the posterior articular surface loss percentage (cutoff point, 37.5%) had a sensitivity >90% and a specificity >80% for the diagnosis of complete in-substance ACL tears.
ACL injuries were seen in 83.2% of the study patients. Complete in-substance ACL tears were associated with an increased incidence of lateral meniscus posterior horn tears. Among PTPF parameters, fracture depression angle and posterior articular surface loss percentage showed a high predictive value for the presence of complete in-substance ACL tears, thereby reducing delays in diagnosis and treatment.
前交叉韧带（ACL）撕裂常伴有后外侧胫骨平台损伤，而后外侧胫骨平台骨折（PTPF）中ACL损伤的发生率尚不清楚。
（1）探讨PTPF患者膝关节韧带（前或后交叉韧带、内或外侧副韧带）及内侧或外侧半月板损伤的发生率；（2）寻找与PTPF相关的可靠参数以预测膝关节韧带和半月板损伤的风险。
横断面研究；证据等级，3级。
确定诊断为PTPF且有计算机断层扫描（CT）和磁共振成像（MRI）数据的患者。在矢状面CT图像上测量PTPF的形态学参数。使用MRI评估膝关节韧带和半月板损伤。分析ACL损伤与半月板损伤的相关性。采用受试者操作特征（ROC）分析来确定PTPF形态学参数对诊断ACL实质内完全撕裂的价值和临界值。
共纳入113例PTPF患者。94例（83.2%）患者存在ACL损伤，其中43例（38.1%）为撕脱骨折，28例（24.8%）为实质内完全撕裂。与其他患者相比，ACL实质内撕裂患者外侧半月板后角撕裂的发生率更高（P <.001）。ROC分析显示，骨折凹陷角（临界值，25.5°）和后关节面损失百分比（临界值，37.5%）对诊断ACL实质内完全撕裂的敏感性>90%，特异性>80%。
83.2%的研究患者存在ACL损伤。ACL实质内完全撕裂与外侧半月板后角撕裂的发生率增加相关。在PTPF参数中，骨折凹陷角和后关节面损失百分比对ACL实质内完全撕裂的存在具有较高的预测价值，从而减少诊断和治疗的延迟。
