The value of magnetic resonance imaging in the preoperative diagnosis of tibial plateau fractures: a systematic literature review

Gregoire Thürig; Alexander Korthaus; Karl-Heinz Frosch; Matthias Krause

doi:10.1007/s00068-022-02127-2

The value of magnetic resonance imaging in the preoperative diagnosis of tibial plateau fractures: a systematic literature review

Eur J Trauma Emerg Surg. 2023 Apr;49(2):661-679. doi: 10.1007/s00068-022-02127-2. Epub 2022 Oct 28.

Authors

Gregoire Thürig^{1

2}, Alexander Korthaus¹, Karl-Heinz Frosch^{1

3}, Matthias Krause⁴

Affiliations

¹ Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany.
² Department of Orthopaedic Surgery and Traumatology, Fribourg Hospital Cantonal, Chem. Des Pensionnats 2-6, 1752, Villars-Sur-Glâne, Switzerland.
³ Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, 21033, Hamburg, Germany.
⁴ Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany. m.krause@uke.de.

Abstract

Purpose: The outcome of a tibial plateau fracture (TPF) depends on the fracture reduction achieved and the extent of soft-tissue lesions, including lesions in the ligaments, cartilage, and menisci. Sub-optimal treatment can result in poor knee function and osteoarthritis. Preoperative planning is primarily based on conventional X-ray and computed tomography (CT), which are unsuitable for diagnosing soft-tissue lesions. Magnetic resonance imaging (MRI) is not routinely performed. To date, no literature exists that clearly states the indications for preoperative MRI. This systematic review aimed to determine the frequency of soft-tissue lesions in TPFs, the association between fracture type and soft-tissue lesions, and the types of cases for which MRI is indicated.

Methods: A systematic review of the literature was based on articles located in PubMed/MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL), supplemented by searching the included articles' reference lists and the ePublication lists of leading orthopedic and trauma journals.

Results: A total of 1138 studies were retrieved. Of these, 18 met the eligibility criteria and included a total of 877 patients. The proportion of total soft-tissue lesions was 93.0%. The proportions of soft-tissue lesions were as follows: medial collateral ligament 20.7%, lateral collateral ligament 22.9%, anterior cruciate ligament 36.8%, posterior cruciate ligament 14.8%, lateral meniscus 48.9%, and medial meniscus 24.5%. A weak association was found between increasing frequency of LCL and ACL lesions and an increase in fracture type according to Schatzker's classification. No standard algorithm for MRI scans of TPFs was found.

Conclusion: At least one ligament or meniscal lesion is present in 93.0% of TPF cases. More studies with higher levels of evidence are needed to find out in which particular cases MRI adds value. However, MRI is recommended, at least in young patients and cases of high-energy trauma.

Keywords: Knee CT; Knee MRI; Ligament knee injury; Preoperative diagnosis; Tibial plateau fracture.

Publication types

Systematic Review
Review

MeSH terms

Anterior Cruciate Ligament Injuries* / diagnostic imaging
Anterior Cruciate Ligament Injuries* / surgery
Humans
Knee Joint
Magnetic Resonance Imaging
Retrospective Studies
Tibial Fractures* / diagnostic imaging
Tibial Fractures* / pathology
Tibial Fractures* / surgery
Tibial Plateau Fractures*