The Effect of Soft Tissue Injuries on Clinical Outcomes after Tibial Plateau Fracture Fixation

Stephen J. Warner, Matthew Garner, Patrick C. Schottel, Peter D. Fabricant, Ryan R. Thacher, Michael L. Loftus, David L. Helfet, Dean G. Lorich

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: To determine if ligamentous and meniscal injuries as determined by initial magnetic resonance imaging altered clinical outcomes after the fixation of tibial plateau fractures. Design: Comparative cohort study. Setting: Academic level I trauma center. Patients/Participants: Eighty-two patients from a prospective database of operatively treated tibial plateau fractures met the inclusion criteria, which consisted of injury radiographs, preoperative knee magnetic resonance imaging (MRI), and a minimum of 12 months of clinical outcomes. Intervention: In addition to radiographs and computed tomography scans for fracture assessment, an MRI was performed to detect tears in the medial and lateral menisci and complete ruptures of the cruciate ligaments (anterior cruciate ligament and posterior cruciate ligament) and collateral ligaments [lateral collateral ligament and medial collateral ligament (MCL)]. Surgical fixation of tibial plateau fractures was performed by a single surgeon based on injury patterns. Main Outcome Measurements: Clinical outcomes included the Knee Outcome Survey Activities of Daily Living Scale, the Lower Extremity Functional Scale, the Short-Form 36, and knee range of motion. Secondary soft tissue surgeries and conversion to arthroplasty were also noted. Results: On injury MRI, 60 patients (73%) had injuries to at least one soft tissue structure. At final follow-up, 2 patients (2%) had a secondary soft tissue surgery and 1 patient (1%) underwent total knee arthroplasty. Patient-reported outcomes and range of motion assessments were not significantly different in patients with and without medial meniscal tears, lateral meniscal tears, and complete MCL ruptures. Conclusions: In this cohort of patients with operative tibial plateau fractures, sutured lateral meniscal tears, untreated medial meniscus tears, and complete MCL ruptures did not significantly affect clinical outcomes. In addition, these data suggest that obtaining a preoperative MRI in patients with tibial plateau fractures to diagnose soft tissue injuries may not alter the surgical treatment or alter patient prognosis for midterm outcomes.

Original languageEnglish (US)
Pages (from-to)141-147
Number of pages7
JournalJournal of orthopaedic trauma
Volume32
Issue number3
DOIs
StatePublished - Mar 1 2018

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Soft Tissue Injuries
Fracture Fixation
Tibial Fractures
Collateral Ligaments
Tibial Meniscus
Tears
Magnetic Resonance Imaging
Wounds and Injuries
Rupture
Knee
Articular Range of Motion
Ankle Lateral Ligament
Posterior Cruciate Ligament
Knee Replacement Arthroplasties
Anterior Cruciate Ligament
Trauma Centers
Activities of Daily Living
Arthroplasty
Lower Extremity
Cohort Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Warner, S. J., Garner, M., Schottel, P. C., Fabricant, P. D., Thacher, R. R., Loftus, M. L., ... Lorich, D. G. (2018). The Effect of Soft Tissue Injuries on Clinical Outcomes after Tibial Plateau Fracture Fixation. Journal of orthopaedic trauma, 32(3), 141-147. https://doi.org/10.1097/BOT.0000000000001042
Warner, Stephen J. ; Garner, Matthew ; Schottel, Patrick C. ; Fabricant, Peter D. ; Thacher, Ryan R. ; Loftus, Michael L. ; Helfet, David L. ; Lorich, Dean G. / The Effect of Soft Tissue Injuries on Clinical Outcomes after Tibial Plateau Fracture Fixation. In: Journal of orthopaedic trauma. 2018 ; Vol. 32, No. 3. pp. 141-147.
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Warner, SJ, Garner, M, Schottel, PC, Fabricant, PD, Thacher, RR, Loftus, ML, Helfet, DL & Lorich, DG 2018, 'The Effect of Soft Tissue Injuries on Clinical Outcomes after Tibial Plateau Fracture Fixation', Journal of orthopaedic trauma, vol. 32, no. 3, pp. 141-147. https://doi.org/10.1097/BOT.0000000000001042

The Effect of Soft Tissue Injuries on Clinical Outcomes after Tibial Plateau Fracture Fixation. / Warner, Stephen J.; Garner, Matthew; Schottel, Patrick C.; Fabricant, Peter D.; Thacher, Ryan R.; Loftus, Michael L.; Helfet, David L.; Lorich, Dean G.

In: Journal of orthopaedic trauma, Vol. 32, No. 3, 01.03.2018, p. 141-147.

Research output: Contribution to journalArticle

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AU - Warner, Stephen J.

AU - Garner, Matthew

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N2 - Objective: To determine if ligamentous and meniscal injuries as determined by initial magnetic resonance imaging altered clinical outcomes after the fixation of tibial plateau fractures. Design: Comparative cohort study. Setting: Academic level I trauma center. Patients/Participants: Eighty-two patients from a prospective database of operatively treated tibial plateau fractures met the inclusion criteria, which consisted of injury radiographs, preoperative knee magnetic resonance imaging (MRI), and a minimum of 12 months of clinical outcomes. Intervention: In addition to radiographs and computed tomography scans for fracture assessment, an MRI was performed to detect tears in the medial and lateral menisci and complete ruptures of the cruciate ligaments (anterior cruciate ligament and posterior cruciate ligament) and collateral ligaments [lateral collateral ligament and medial collateral ligament (MCL)]. Surgical fixation of tibial plateau fractures was performed by a single surgeon based on injury patterns. Main Outcome Measurements: Clinical outcomes included the Knee Outcome Survey Activities of Daily Living Scale, the Lower Extremity Functional Scale, the Short-Form 36, and knee range of motion. Secondary soft tissue surgeries and conversion to arthroplasty were also noted. Results: On injury MRI, 60 patients (73%) had injuries to at least one soft tissue structure. At final follow-up, 2 patients (2%) had a secondary soft tissue surgery and 1 patient (1%) underwent total knee arthroplasty. Patient-reported outcomes and range of motion assessments were not significantly different in patients with and without medial meniscal tears, lateral meniscal tears, and complete MCL ruptures. Conclusions: In this cohort of patients with operative tibial plateau fractures, sutured lateral meniscal tears, untreated medial meniscus tears, and complete MCL ruptures did not significantly affect clinical outcomes. In addition, these data suggest that obtaining a preoperative MRI in patients with tibial plateau fractures to diagnose soft tissue injuries may not alter the surgical treatment or alter patient prognosis for midterm outcomes.

AB - Objective: To determine if ligamentous and meniscal injuries as determined by initial magnetic resonance imaging altered clinical outcomes after the fixation of tibial plateau fractures. Design: Comparative cohort study. Setting: Academic level I trauma center. Patients/Participants: Eighty-two patients from a prospective database of operatively treated tibial plateau fractures met the inclusion criteria, which consisted of injury radiographs, preoperative knee magnetic resonance imaging (MRI), and a minimum of 12 months of clinical outcomes. Intervention: In addition to radiographs and computed tomography scans for fracture assessment, an MRI was performed to detect tears in the medial and lateral menisci and complete ruptures of the cruciate ligaments (anterior cruciate ligament and posterior cruciate ligament) and collateral ligaments [lateral collateral ligament and medial collateral ligament (MCL)]. Surgical fixation of tibial plateau fractures was performed by a single surgeon based on injury patterns. Main Outcome Measurements: Clinical outcomes included the Knee Outcome Survey Activities of Daily Living Scale, the Lower Extremity Functional Scale, the Short-Form 36, and knee range of motion. Secondary soft tissue surgeries and conversion to arthroplasty were also noted. Results: On injury MRI, 60 patients (73%) had injuries to at least one soft tissue structure. At final follow-up, 2 patients (2%) had a secondary soft tissue surgery and 1 patient (1%) underwent total knee arthroplasty. Patient-reported outcomes and range of motion assessments were not significantly different in patients with and without medial meniscal tears, lateral meniscal tears, and complete MCL ruptures. Conclusions: In this cohort of patients with operative tibial plateau fractures, sutured lateral meniscal tears, untreated medial meniscus tears, and complete MCL ruptures did not significantly affect clinical outcomes. In addition, these data suggest that obtaining a preoperative MRI in patients with tibial plateau fractures to diagnose soft tissue injuries may not alter the surgical treatment or alter patient prognosis for midterm outcomes.

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