title: The usefulness of MRI and arthroscopy in the diagnosis and treatment of soft-tissue injuries associated with split-depression fractures of the lateral tibial condyle.
abstract: The role of arthroscopy in the treatment of soft-tissue injuries associated with proximal tibial fractures remains debatable. Our hypothesis was that MRI over-diagnoses clinically relevant associated soft-tissue injuries. This prospective study involved 50 consecutive patients who underwent surgical treatment for a split-depression fracture of the lateral tibial condyle (AO/OTA type B3.1). The mean age of patients was 50 years (23 to 86) and 27 (54%) were female. All patients had MRI and arthroscopy. Arthroscopy identified 12 tears of the lateral meniscus, including eight bucket-handle tears that were sutured and four that were resected, as well as six tears of the medial meniscus, of which five were resected. Lateral meniscal injuries were diagnosed on MRI in four of 12 patients, yielding an overall sensitivity of 33% (95% confidence interval (CI) 11 to 65). Specificity was 76% (95% CI 59 to 88), with nine tears diagnosed among 38 menisci that did not contain a tear. MRI identified medial meniscal injuries in four of six patients, yielding an overall sensitivity of 67% (95% CI 24 to 94). Specificity was 66% (95% CI 50 to 79), with 15 tears diagnosed in 44 menisci that did not contain tears. MRI appears to offer only a marginal benefit as the specificity and sensitivity for diagnosing meniscal injuries are poor in patients with a fracture. There were fewer arthroscopically-confirmed associated lesions than reported previously in MRI studies.
authors.affiliation: Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Parkkinen
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Fruit Street, Jackson 1126, Boston, Massachusetts 02114, USA.
authors.forename: R
authors.initials: R
authors.lastname: Madanat
authors.affiliation: Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada.
authors.forename: T J
authors.initials: TJ
authors.lastname: Mäkinen
authors.affiliation: Omasairaala Oy, Puutarhurinkuja 2, 00300 Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Mustonen
authors.affiliation: Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland.
authors.forename: S K
authors.initials: SK
authors.lastname: Koskinen
authors.affiliation: Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Lindahl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013978:Tibial Fractures / Q000150:complications*; D000070600:Tibial Meniscus Injuries
keywords: Arthroscopy; Concomitant injury; Fracture; Lateral tibial condyle; MRI