Tibial plateau fractures are associated with a broad spectrum of injuries.
Associated soft tissue injuries in tibial plateau fractures can be divided as soft tissue
envelope lesions, neurovascular injuries and intra-articular lesions. Careful
preoperative soft tissue envelope management is important in avoiding additional
injury. The neurovascular status of the extremity must be evaluated, although
concomitant injuries of neurovascular structures are rare. Lesions of the ligaments
and/or the menisci has been reported in several studies and may contribute, if not
properly treated, to the substandard outcomes associated with this type of fractures.
Traditionally, meniscal tears are reported in 20-50% cases of all the tibial plateau
fractures, while ligaments lesions are reported in 10-30%. Even if the examination of
knee stability and of the conditions of menisci and ligaments is not so easy, is
recommended to perform a careful evaluation of the patient in order to determine
associated ligamentous damage. The imaging studies routinely performed for tibial
plateau fractures are plain anteroposterior and lateral radiographs and threedimensional
CT, while MRI has not yet become a standard tool. The final outcome of
surgical treatment may be influenced by associated lesions of the menisci or of the knee
ligaments. There is a wide uniformity of behaviours in treating meniscal tears: central
tears in white zone must be resected, while peripheral lesions in red zone and
meniscocapsular disjunction must be repaired. Ligamentous injuries associated with
bony avulsion should be acutely treated during fracture fixation; in the absence of bony
avulsion, functional and residual laxity should be addressed at a later date.
Keywords: Bony avulsion, Ligamentous injuries, Meniscal tears, Repair, Soft
tissue.
