Summary

Soft tissue knee injuries are common after proximal tibia fractures, with 2 in 3 people affected.

Abstract

Introduction

Proximal tibial fractures account for 1% of all fractures and are associated with poor function and long-term disability. Suboptimal treatment of the soft tissue injuries at the time of the index operation is a potentially modifiable factor that may hinder recovery after these fractures. However, the existing literature on the prevalence of such injuries is poor. This review aims to estimate the prevalence of meniscal, cruciate and collateral ligament injuries after proximal tibial fractures.

Methods

MEDLINE, Embase, CINAHL and CENTRAL were searched until 31st March 2024. Studies were included if they reported prevalence data on soft tissue knee injuries in an unselected, consecutive population of adults (>18 years) with proximal tibial fractures. The primary outcomes were the prevalence of meniscal, cruciate and collateral ligament injuries. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the methodological quality of the included studies.

Results

Following screening of 2434 records, a total of 24 studies representing 1104 adults were included. The average age was 47 years and 689 (62.4%) were male. The pooled prevalence of meniscal, cruciate or collateral ligament injury was 63% (95% CI: 50-76, I2=98%, p < 0.001); meniscal injury 60% (95% CI: 54-66, I2=76%, p = 0.02); cruciate ligament injury 58% (95% CI: 44-72%, I2=100%, p < 0.001); and collateral ligament injury 66% (95% CI: 47-85, I2=100, p < 0.001).

Discussion

The prevalence of soft tissue knee injuries after proximal tibial fractures is high. Our findings advocate for the use of pre-operative MRI in this population and consideration of concurrent surgical management of associated ligamentous and/or meniscal injuries. There is a high risk of post-traumatic arthritis following proximal tibial fractures and further work is needed to assess whether managing associated soft tissue injuries influences this risk.

Conclusion

Approximately 2 in 3 adults with a proximal tibia fracture an injury to one of the menisci, cruciate or collateral ligaments. Unmanaged ligamentous or meniscal injuries may influence the outcomes in this patient population.