2021 ISAKOS Biennial Congress ePoster
An Mri-Based Classification System For Radiologists & Clinicians Allowing To Efficiently Evaluate The Damage To The Posterior Margin Of The Lateral Tibial Plateau: Updated Findings From A Multi-Centre Retrospective Analysis Of Patients With Acute Acl Inju
Robert Smigielski, MD, PhD, Warsaw, masovian POLAND
Beata Ciszkowska-Lyson, PhD, Warsaw POLAND
Bartosz Tomasz Dominik, MD, Warsaw POLAND
Aleksandra Zielinska, MA, BSc, Warsaw, masovian POLAND
Mirco Herbort, MD, Prof., Munich GERMANY
Christian Fink, MD, Prof., Innsbruck AUSTRIA
Carolina Medical Center & LIFE Institute, `Warsaw, masovian, POLAND
FDA Status Not Applicable
Summary
The study's objective was to validate the „Warsaw“ classification system designed as a tool for clinicians and radiologists allowing to properly detect and assess the extent of the damage to the posterior tibial plateau and decide further surgical treatment.
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Abstract
Introduction
Bone bruises (BB) of the posterior margin of the tibia are commonly observed in patients with anterior cruciate ligament (ACL) injuries (64-94%). Depending on the force and mechanism of injury the extent of the damage may vary from light to moderate bruising but in more severe cases a compression fracture occurs. The authors' observations combined with literature research indicate that the disruption of the articular surface dedicated for the lateral meniscus (LM) may affect knee biomechanics, creating an environment for the occurrence of early-onset osteoarthritis.
Objectives:
To confirm the frequency of ACL ruptures combined with a compression fracture of the posterior margin of the lateral tibial plateau (PLTF) and to validate the „Warsaw“ classification system designed as a tool for clinicians and radiologists allowing them to properly assess the extent of the damage to the posterior tibial plateau and decide further surgical treatment.
Methods
A retrospective multi-centre study of 589 MRIs (1.5Tesla GE Signa HDXt machine) of patients (209 women and 254 men) with diagnosed acute ACL injury was conducted in two European orthopaedic centres. The evaluation process included visual the assessment of LM's position on the tibial plateau in all available planes, however the basis for the classification were the sagittal PD images.
Results
Based on radiological measurements and analysis, a IV-grade classification has been proposed: grade I - oedema resulting from the contusion of the bone, no changes in the bone shape; grade II - slight compression, but the meniscus is still fully supported; grade III - bone degradation, only about 50% support of the meniscus; grade IV - less than 50% support for the meniscus. Out of 589 cases, BB were found in 463 (78,60%). BB cases were classified as follows (per cents calculated for the BB group): grade I - 94 (20,30%); grade II - 270 (58,31%); grade III - 73 (15,75%); grade IV - 26 (5,61%).
Conclusions
The classification makes it possible to detect and assess the loss of support for the meniscus, which plays a major role in knee biomechanics. Acquiring this information, should the classification become a valid diagnostic tool, would aid orthopaedic surgeons while deciding comprehensive surgical treatment at the time of ACL injury, that would minimise the risk of maintaining knee instability or early-onset osteoarthritis. In the authors' opinion, grades III and IV (amounting to 21,37% of cases covered by this study) require the reduction of the compressed bone at the time of ACL reconstruction.