Abstract：
BACKGROUND: Currently there is no consensus on the need for investigating knee ligamentous and meniscal injuries in a patient with a tibial plateau fracture. Consequently, many soft tissue injuries are likely undiagnosed and therefore untreated. The impact this has on long term knee outcomes is not well defined. We aimed to identify the impacts of various diagnostic methods on the management of meniscal injuries associated with tibial plateau fractures and evaluate the clinical outcomes.
METHODS: We performed a systematic review using Pubmed, Medline, Embase, CINAHL and Cochrane following Cochrane guidelines. We included studies that operatively managed tibial plateau fractures and soft tissue injuries, which were diagnosed with either preoperative MRI, intra-operative arthroscopy or arthrotomy.
RESULTS: 18 articles with 884 people, with a mean age of 46.4 years were included. Soft tissue injuries were detected on MRI (32-73%) and arthroscopy (12-70%), of which the most common were lateral meniscal injuries (7-64% of tibial plateau fractures). When identified by arthroscopy and arthrotomy, these injuries were almost always treated, either by repair or debridement. The clinical outcomes of these patients were poorly reported, with a heterogenous use of patient reported outcome measures, and follow up time points. There were no randomised trials or control groups for comparative analysis, however operative treatment yielded good to excellent outcomes.
CONCLUSIONS: There is a high incidence of concomitant soft tissue injuries with tibial plateau fractures, particularly lateral meniscal injuries. There are 2 main approaches to meniscal injuries: surgeons who don\'t investigate, don\'t treat, whilst surgeons who do investigate often do surgically treat. Although studies that treated these injuries achieved good to excellent results, the currently available evidence doesn\'t confirm treatment superiority. As there is plausibility for better outcomes, randomised studies are needed to further investigate this clinical question.
METHODS: We performed a systematic review using Pubmed, Medline, Embase, CINAHL and Cochrane following Cochrane guidelines. We included studies that operatively managed tibial plateau fractures and soft tissue injuries, which were diagnosed with either preoperative MRI, intra-operative arthroscopy or arthrotomy.
RESULTS: 18 articles with 884 people, with a mean age of 46.4 years were included. Soft tissue injuries were detected on MRI (32-73%) and arthroscopy (12-70%), of which the most common were lateral meniscal injuries (7-64% of tibial plateau fractures). When identified by arthroscopy and arthrotomy, these injuries were almost always treated, either by repair or debridement. The clinical outcomes of these patients were poorly reported, with a heterogenous use of patient reported outcome measures, and follow up time points. There were no randomised trials or control groups for comparative analysis, however operative treatment yielded good to excellent outcomes.
CONCLUSIONS: There is a high incidence of concomitant soft tissue injuries with tibial plateau fractures, particularly lateral meniscal injuries. There are 2 main approaches to meniscal injuries: surgeons who don\'t investigate, don\'t treat, whilst surgeons who do investigate often do surgically treat. Although studies that treated these injuries achieved good to excellent results, the currently available evidence doesn\'t confirm treatment superiority. As there is plausibility for better outcomes, randomised studies are needed to further investigate this clinical question.
摘要：
背景：目前对胫骨平台骨折患者的膝关节韧带和半月板损伤的研究没有共识。因此,许多软组织损伤可能未被诊断，因此未经治疗。这对长期膝关节结果的影响尚不明确。我们旨在确定各种诊断方法对胫骨平台骨折相关半月板损伤处理的影响，并评估临床结果。
方法：我们使用Pubmed，Medline,Embase,CINAHL和Cochrane遵循Cochrane指南。我们纳入了手术治疗胫骨平台骨折和软组织损伤的研究，被诊断为术前MRI，术中关节镜或关节切开术。
结果：18篇文章，884人，包括平均年龄46.4岁.在MRI（32-73％）和关节镜（12-70％）上检测到软组织损伤，其中最常见的是外侧半月板损伤（胫骨平台骨折的7-64％）。当通过关节镜和关节切开术确定时，这些伤口几乎总是得到治疗，通过修复或清创。这些患者的临床结果报告不佳，由于患者报告的结果指标的异质性使用，并跟踪时间点。没有随机试验或对照组进行比较分析，然而，手术治疗取得了良好至优异的结果。
结论：胫骨平台骨折合并软组织损伤的发生率较高，尤其是外侧半月板损伤。半月板损伤有两种主要方法：不调查的外科医生，不要请客，而做调查的外科医生经常做手术治疗。尽管治疗这些损伤的研究取得了良好到优异的结果，目前现有的证据并不能证实治疗的优越性。由于有可能获得更好的结果，需要随机研究来进一步研究这一临床问题.
方法：我们使用Pubmed，Medline,Embase,CINAHL和Cochrane遵循Cochrane指南。我们纳入了手术治疗胫骨平台骨折和软组织损伤的研究，被诊断为术前MRI，术中关节镜或关节切开术。
结果：18篇文章，884人，包括平均年龄46.4岁.在MRI（32-73％）和关节镜（12-70％）上检测到软组织损伤，其中最常见的是外侧半月板损伤（胫骨平台骨折的7-64％）。当通过关节镜和关节切开术确定时，这些伤口几乎总是得到治疗，通过修复或清创。这些患者的临床结果报告不佳，由于患者报告的结果指标的异质性使用，并跟踪时间点。没有随机试验或对照组进行比较分析，然而，手术治疗取得了良好至优异的结果。
结论：胫骨平台骨折合并软组织损伤的发生率较高，尤其是外侧半月板损伤。半月板损伤有两种主要方法：不调查的外科医生，不要请客，而做调查的外科医生经常做手术治疗。尽管治疗这些损伤的研究取得了良好到优异的结果，目前现有的证据并不能证实治疗的优越性。由于有可能获得更好的结果，需要随机研究来进一步研究这一临床问题.
