Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury?
OBJECTIVE
(1) To determine the accuracy of computed tomography (CT) in the evaluation of ligament tear and avulsion in patients with tibial plateau fracture. (2) To evaluate whether the presence or severity of fracture gap and articular depression can predict meniscal injury.


METHODS
A fellowship-trained musculoskeletal radiologist retrospectively reviewed knee CT and MRI examinations of 41 consecutive patients presenting to a level 1 trauma center with tibial plateau fractures. Fracture gap, articular depression, ligament tear and footprint avulsions were assessed on CT examinations. The MRI studies were examined for osseous and soft tissue injuries, including meniscal tear, meniscal displacement, ligament tear, and ligament avulsion.


RESULTS
CT demonstrated torn ligaments with 80% sensitivity and 98% specificity. Only 2% of ligaments deemed intact on careful CT evaluation had partial or complete tears on MRI. Although the degree of fracture gap and articular depression was significantly greater in patients with meniscal injury compared with those without meniscal injury, ROC analysis demonstrated no clear threshold for gap or depression that yielded a combination of high sensitivity and specificity.


CONCLUSIONS
In the acute setting, CT offers high sensitivity and specificity for depicting osseous avulsions, as well as high negative predictive value for excluding ligament injury. However, MRI remains necessary for the preoperative detection of meniscal injury.
Mui
Leonora W
LW
Department of Radiology, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway, Bronx, NY 10461, USA.
Engelsohn
Eliyahu
E
Umans
Hilary
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis*; D008022:Ligaments / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008592:Menisci, Tibial / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging* / Q000473:pathology*; D015203:Reproducibility of Results; D012421:Rupture / Q000000981:diagnostic imaging / Q000473:pathology; D012680:Sensitivity and Specificity; D000070600:Tibial Meniscus Injuries; D014057:Tomography, X-Ray Computed / Q000379:methods*