Prediction of lateral meniscal tear in patients with Schatzker II tibial plateau fractures based upon preoperative X-ray: a retrospective study
Authors: Fang Run , Liu Yulong , Ning Rende , Tu Bizhi , Zhang Chengnan 
Published: December 2023

Background
Tibial plateau fractures frequently coexist with lateral meniscus injuries, yet not all patients with tibial plateau fractures are eligible for preoperative MRI examination to diagnose the presence of meniscus injury. The aim of our study was to explore the association between radiographic morphological features of tibial plateau fractures and lateral meniscus injuries.
Methods
A retrospective analysis was conducted on 108 patients with Schatzker II tibial plateau fractures who underwent open reduction internal fixation surgery in our hospital between December 2019 and June 2022. Arthroscopic evaluation of lateral meniscus injuries was performed immediately after satisfactory fracture reduction, and patients were categorized into the meniscal tear group (n = 59) or non-tear group (n = 49) based on the presence or absence of meniscal tears. The preoperative X-ray measurements of tibial plateau widening (TPW), lateral plateau depression (LPD), lateral fragment width (LFW), and coronal angulation of the lateral fragment (CALF) were analyzed to determine their correlation with lateral meniscus injuries in Schatzker II tibial plateau fractures. Receiver operating characteristic (ROC) curves were plotted to establish the optimal cut-off point for these parameters in predicting such injuries.
Results
The prevalence of lateral meniscal tears in our patient cohort was 54.6% (59/108), with no significant differences found between the tear and non-tear groups in terms of age, gender, injury side, BMI, or time from injury to surgery (P > 0.05). The meniscal tear group had a significantly higher mean TPW of 6.4 ± 1.4mm compared to the non-tear group's mean TPW of 5.4 ± 1.1mm (P < 0.05). Additionally, the meniscal tear group had a significantly higher mean LPD of 10.5 ± 2.8mm compared to the non-tear group's mean LPD of 8.2 ± 2.9mm (P < 0.05). There was no significant difference in the mean LFW between the two groups, with values of 21.0 ± 2.2mm and 20.1 ± 2.4mm for the meniscal tear and non-tear groups, respectively (P > 0.05). However, there was a significant difference in the mean CALF between the two groups, with values of 20.0 ± 5.0° and 17.6 ± 4.0° for the meniscal tear and non-tear groups, respectively (P < 0.05). The ROC curve areas for TPW, LPD, and CALF in predicting lateral meniscal tears in Schatzker II tibial plateau fractures were 0.694 (95% CI: 0.596 ~ 0.792, P = 0.001), 0.710 (95% CI: 0.612 ~ 0.809, P = 0.000), and 0.632 (95% CI: 0.527 ~ 0.737, P = 0.018) respectively with optimal cut-off values of 6.5mm, 9.1mm and20.3°.
Conclusions
When preoperative X-ray measurements of Schatzker II tibial plateau fractures indicate TPW > 6.5mm, LPD > 9.1mm, or CALF > 20.3°, it strongly suggests the possibility of lateral meniscal injury. Surgeons should exercise heightened vigilance during the operation to ascertain the presence of meniscal tears and promptly administer suturing or appropriate treatment if detected.