Sat., 10/6/12 Femur/Tibial Fx/Knee Injuries, PAPER #78, 9:15 am OTA-2012
The Incidence of Meniscal Tears Requiring Repair in Tibial Plateau Fractures: A Review of 670 Patients
Daniel L. Stahl, MD; Rafael Serrano-Riera, MD; Bradley Deafenbaugh, MD;
Roy Sanders, MD; H. Claude Sagi, MD;
Florida Orthopedic Institute, Tampa, Florida, USA
Background/Purpose: Based on publications using preoperative MRI studies, the incidence of meniscal tears in patients with tibial plateau fractures has been reported to vary from 40% to 80%. The purposes of this study are to determine (1) the incidence of meniscal tears noted intraoperatively that required repair, and (2) if a correlation exists between type of plateau fracture (Schatzker and OTA classification) and incidence of meniscal tear.
Methods: Tibial plateau fractures in skeletally mature patients treated operatively from 2002 to 2011 were included in the study. All operative notes, initial history and physicals, and radiographs were retrospectively reviewed to determine type of tibial plateau fracture (Schatzker and OTA classification), mechanism of injury, and intraoperative detection of meniscal tear. Patients were excluded if there was no mention of submeniscal arthrotomy or if surgical stabilization was performed percutaneously. Statistical analysis was performed using χ2 analysis and Fisher exact testing to determine the overall incidence of meniscal tears and any correlation with meniscal tear and type of tibial plateau fracture.
Results: 670 patients were included in the final analysis. Meniscal tears were found in 207 patients, making the overall incidence of meniscal tears detected intraoperatively 31%. Schatzker II (OTA 41-B3) tibial plateau fractures had a significantly higher incidence of meniscal tears compared to all other Schatzker classifications (P <0.001). The incidence of meniscal tears associated with each Schatzker fracture pattern was: 12% for type I fractures, 45% for type II fractures, 17% for type III fractures, 15% for type IV, 24% for type V, and 30% for type VI. For the meniscal tears associated with the Schatzker II fractures (n = 203), peripheral tears were most common (53% of tears). For the other fracture patterns, the type of meniscal injury was evenly distributed between peripheral, radial, and bucket-handle tear.
Conclusion: This is the largest intraoperative study performed to date determining the incidence of meniscal tears in tibial plateau fractures. Our results show a much lower incidence (30%) of meniscal tears detected intraoperatively that require repair than previously reported in the literature with studies utilizing preoperative MRI (up to 90%). Meniscal tears needing repair associated with tibial plateau fractures are most commonly peripheral rim tears seen in the Schatzker II variant.
Alphabetical Disclosure Listing (808K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.