Displaced osteochondral fracture of the posterolateral tibial plateau associated with an acute anterior cruciate ligament injury

Andrade, Marco Antônio Percope de; Pimenta, Frederico Silva; Silva, Guilherme Moreira de Abreu e; Pires, Robinson Esteves Santos

doi:10.1016/j.tcr.2019.100172

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…These injuries, also known as "apple-bite" fractures, represent the most frequent indirect sign of ACL tear. 3,5,22,29 Also, lateral meniscus tears and impaction of the lateral femoral condyle are frequently associated with these injuries. 3,5,22,30 Chang et al found both a greater risk of lateral meniscus injury with more than 6.3 mm of lateral joint depression and of ACL tear when the volumetric lateral joint depression is less than 209.6 mm 2 , and/or there is more than 5.7-mm lateral joint widening.…”

Section: Surgical Techniques For Reconstructionmentioning

confidence: 99%

Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm

et al. 2020

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High-energy fractures of the proximal tibia with extensive fragmentation of the posterolateral (PL) quadrant of the tibial plateau are challenging to manage. Herein, we present a review of the literature on the patterns and options of approach and fixation of the PL fragment of the tibial plateau to optimize the treatment of this specific injury pattern. We searched PubMed (1980–May 2020) to identify and summarize the most relevant articles evaluating both the morphology and treatment recommendations, including the choice of approach and fixation strategy, for the PL tibial plateau fracture. We found PL fragment can present in several patterns as a pure split, split depression, contained pure depression, and noncontained depression (rim crush), which are mostly determined by the position of the knee and the force magnitude applied during the course of the accident. Based on previous concepts described by Schatzker and Kfuri, we suggest a simplified treatment algorithm highlighting the two concepts (buttressing and containment) used for plating the PL tibial plateau fragments. Based on the available current evidence, we propose an algorithm for these two morphological types of PL tibial plateau fracture. Shear-type fractures need buttressing (the “rule of thumb”), whereas noncontained peripheral rim-type fractures need peripheral repair and containment. Contained pure depression fractures are not frequent and need percutaneous-assisted elevation and subchondral rafting, either controlled by fluoroscopy or arthroscopically. It is believed that such an approach would simplify their assessment and preoperative planning and would assist the clinicians to appreciate and manage more consistently these complex injuries.

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Section: Surgical Techniques For Reconstructionmentioning

confidence: 99%

Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm

et al. 2020

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“…The tibiofibular arch plays an important role in bearing downward forces of the lateral compartment of the knee joint. 5 , 16 Therefore, we speculate that bone bruises of the fibular head occurred because of a large degree of traumatic energy that could not be limited to the lateral tibial plateau. Our hypothesis was supported by our finding that no patient had a grade I bone bruise classified as type d, which shows that the energy was too small to reach the fibular head in patients with grade I bone bruises.…”

Section: Discussionmentioning

confidence: 96%

Classification of Bone Bruises in Pediatric Patients With Anterior Cruciate Ligament Injuries

Wang

Zhang

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Bone bruises are frequently found on magnetic resonance imaging (MRI) after an anterior cruciate ligament (ACL) tear in pediatric patients. Purpose: To establish a classification system for different bone bruise patterns to estimate the severity of a knee injury in pediatric patients with ACL tears. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A medical database was retrospectively reviewed to identify all cases of primary ACL tears in patients who were aged ≤17 years at the time of the injury and underwent MRI at our institution within 4 weeks of the injury between January 2011 and December 2020. A total of 188 patients were identified (67 male, 121 female; mean age, 15.1 ± 1.4 years). Bone bruises were classified according to their depth and location on MRI in the sagittal and coronal planes. Results: The new classification system identified 3 grades of depth: grade I, the bone bruise was located within the epiphysis but did not reach the epiphyseal plate (n = 54 [35.3%]); grade II, the bone bruise was within the epiphysis that reached the epiphyseal plate (n = 55 [35.9%]); and grade III, the bone bruise was in both the epiphysis and metaphysis (n = 44 [28.8%]). The bone bruise location was classified into 4 types: type a, the deepest bone bruise area was in the lateral tibial plateau (n = 66 [43.1%]); type b, the deepest bone bruise area was in the lateral femoral condyle, commonly occurring in the lateral one-third to two-thirds of the lateral femoral condyle (n = 22 [14.4%]); type c, the bone bruise area had a similar depth in both the lateral femoral condyle and lateral tibial plateau (n = 54 [35.3%]); and type d, the bone bruise area was in the lateral tibial plateau and lateral femoral condyle and extended to the fibular head (n = 11 [7.2%]). The prevalence of collateral ligament injuries increased from grade I to III. All patients with grade III type c bone bruises had meniscal lesions. Conclusion: This new classification system provides a basis for estimating associated lesions of the knee before surgery.

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“…Giordano et al [ 8 ] described these posterolateral corner sheared fractures of the tibial plateau as “apple-bite” fractures, which were rare and infrequently mentioned in previously published reports. Also, these fractures were typically associated with ACL rupture, lateral meniscus injury, and MCL tears, due to rotational trauma when the knee was in a slight valgus position and flexed [ 8 – 10 ]. In some cases with possible ACL rupture, it is challenging to diagnose posterolateral corner rim fractures with radiographs due to the superimposition of the larger medial condyle [ 11 ].…”

Section: Case Presentationmentioning

confidence: 99%

A posterolateral sheared fracture of the tibial plateau: a case presentation

Feng

WuJi

et al. 2021

BMC Musculoskelet Disord

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Background Among tibial plateau fractures, one specialized type is the posterolateral column fracture. There are few published studies on posterolateral tibial plateau fractures with a sheared fragment that was wedged into the intercondylar fossa without the anterior cruciate ligament (ACL) rupture. According to our research, this case presentation is the first to describe in detail the treatment and long-term follow-up for this uncommon subtype of posterolateral tibial plateau fracture. Case presentation A 46-year-old female injured her right knee when she was riding a motorbike and was diagnosed with a posterolateral sheared tibial plateau fracture with a wedge-shaped fragment inserted into the femoral intercondylar fossa. The fracture was repaired with open reduction internal fixation surgery. The patient’s recovery was followed for four years. The degree of healing as indicated by clinical and radiological examinations was substantial. The patient exhibited an excellent range of motion for the repaired knee (0-145°) and little discomfort. The Lysholm score was 96, the hospital for special surgery score was 98, the Rasmussen clinical assessment was 28, and the Rasmussen radiological assessment was 18. Conclusion This study revealed that a posterolateral sheared tibial plateau, as seen in this case, can be reset and fixed sufficiently to achieve excellent long-term postoperative recovery.

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Displaced osteochondral fracture of the posterolateral tibial plateau associated with an acute anterior cruciate ligament injury

Cited by 6 publications

References 15 publications

Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm

Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm

Classification of Bone Bruises in Pediatric Patients With Anterior Cruciate Ligament Injuries

A posterolateral sheared fracture of the tibial plateau: a case presentation

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