title: Correlation of parameters on preoperative CT images with intra-articular soft-tissue injuries in acute tibial plateau fractures: A review of 132 patients receiving ARIF.
abstract: BACKGROUND
  Tibial plateau fractures often occur in conjunction with soft-tissue injuries of knees. The hypothesis of this study is that parameters of CT imaging can predict intra-articular soft-tissue injuries.
  
  
  METHODS
  Patients who underwent arthroscopically assisted reduction and internal fixation (ARIF) for acute tibial plateau fractures performed by a single orthopedic surgeon between 2005 and 2015 were included in this retrospective study. Patients with concomitant ipsilateral femoral fractures, who had received revision surgery or who had undergone index surgery more than 30days from the event were excluded. We measured lateral plateau depression and widening, medial plateau depression and displacement, and column involvement observed on preoperative CT scans. Intra-articular soft-tissue injuries were diagnosed based on findings from knee arthroscopy. The correlation of imaging parameters with soft-tissue injuries was analyzed by the area under a receiver operating characteristic (AUROC) curve and multivariate logistic regression.
  
  
  RESULTS
  One-hundred and thirty-two patients were enrolled in the study. The average age was 45.7±13.1 years (range: 18-75 years). Lateral tibial plateau depressions >11mm were significantly associated with increased risk of lateral meniscus tears (p=0.001). However, there was no significant threshold of lateral tibial plateau widening that could be used to predict lateral meniscus tear. Greater risk of anterior cruciate ligament (ACL) avulsion fracture was observed in younger patients, patients with high-energy-pattern tibial plateau fractures, patients with fractures involving anteromedial or posterolateral columns, and patients with medial tibial plateau displacement >3mm (p<0.05).
  
  
  CONCLUSIONS
  Measuring lateral tibial plateau depression and column involvement on preoperative CT scans can help predict a higher risk of lateral meniscus tear and ACL avulsion fracture respectively in patients with acute tibial plateau fractures.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Hao-Che
authors.initials: HC
authors.lastname: Tang
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Orthopaedic Surgery, Division of Sports Medicine Section, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: I-Jung
authors.initials: IJ
authors.lastname: Chen
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Orthopaedic Surgery, Division of Sports Medicine Section, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Yu-Cheng
authors.initials: YC
authors.lastname: Yeh
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Orthopaedic Surgery, Division of Sports Medicine Section, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Chun-Jui
authors.initials: CJ
authors.lastname: Weng
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Orthopaedic Surgery, Division of Sports Medicine Section, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Shih-Sheng
authors.initials: SS
authors.lastname: Chang
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Orthopaedic Surgery, Division of Sports Medicine Section, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Alvin Chao-Yu
authors.initials: AC
authors.lastname: Chen
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Orthopaedic Surgery, Division of Sports Medicine Section, Chang Gung Memorial Hospital, Linkou, Taiwan. Electronic address: yschan512@gmail.com.
authors.forename: Yi-Sheng
authors.initials: YS
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000070598:Anterior Cruciate Ligament Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology; D022125:Lacerations; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013624:Taiwan / Q000453:epidemiology; D013978:Tibial Fractures / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D000070600:Tibial Meniscus Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: ACL avulsion; Arthroscopy; CT; Meniscus tear; Tibial plateau fracture