Hassan AAA, Khalifa AA, Villalon AR, Hauri D, Zhu TY. Predictive value of preoperative computed tomography parameters for meniscal and cruciate ligament injuries in tibial plateau fractures: Meta-analysis. World J Orthop 2026; 17(4): 116076 [DOI: 10.5312/wjo.v17.i4.116076]
Corresponding Author of This Article
Ahmed A Khalifa, MD, Assistant Professor, FRCS, Department of Orthopaedic, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga Highway, Qena 83523, Qina, Egypt. ahmed_adel0391@med.svu.edu.eg
Research Domain of This Article
Orthopedics
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Apr 18, 2026; 17(4): 116076 Published online Apr 18, 2026. doi: 10.5312/wjo.v17.i4.116076
Predictive value of preoperative computed tomography parameters for meniscal and cruciate ligament injuries in tibial plateau fractures: Meta-analysis
Ahmed Abdelazim A Hassan, Ahmed A Khalifa, Antia Rodriguez Villalon, Dimitri Hauri, Tracy Y Zhu
Ahmed Abdelazim A Hassan, Department of Orthopaedics and Trauma Surgery, Assiut University Hospital, Assiut 71515, Egypt
Ahmed A Khalifa, Department of Orthopaedic, Qena Faculty of Medicine and University Hospital, South Valley University, Qena 83523, Qina, Egypt
Ahmed A Khalifa, Department of Orthopedic, Aster Sanad Hospital, Riyadh 14236, Saudi Arabia
Antia Rodriguez Villalon, Dimitri Hauri, Tracy Y Zhu, AO Innovation Translation Center, AO Foundation, Davos 7270, Graubünden, Switzerland
Co-first authors: Ahmed Abdelazim A Hassan and Ahmed A Khalifa.
Author contributions: Hassan AAA and Khalifa AA performed manuscript preparation, editing, and proofreading, and they contributed equally to this manuscript as co-first authors; Hassan AAA and Zhu TY contributed to the conceptualization of the protocol and formulated the literature search strategy; Hassan AAA and Villalon AR contributed to the literature screening, data extraction, and risk of bias assessment; Hauri D performed the statistical analysis; Zhu TY revised the final manuscript version. All authors reviewed and approved the final manuscript version.
Supported by the AO Foundation via the AO Innovation Translation Center Clinical Research Fellowship (partner with AO Trauma).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Ahmed A Khalifa, MD, Assistant Professor, FRCS, Department of Orthopaedic, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga Highway, Qena 83523, Qina, Egypt. ahmed_adel0391@med.svu.edu.eg
Received: November 2, 2025 Revised: November 19, 2025 Accepted: January 28, 2026 Published online: April 18, 2026 Processing time: 159 Days and 22.6 Hours
Abstract
BACKGROUND
Tibial plateau fractures (TPFs), although comprising only 1% of all fractures, pose significant diagnostic and management challenges due to their frequent association with meniscal and ligamentous injuries. Computed tomography (CT), widely employed in preoperative assessment of TPFs, may provide predictive insights into soft tissue injuries.
AIM
To evaluate the diagnostic accuracy of preoperative quantitative CT parameters in predicting meniscal and cruciate ligament injuries associated with TPFs.
METHODS
A systematic review was conducted per the PRISMA guidelines. Two databases (PubMed and Scopus) were searched up to October 2024. Studies were included if they involved skeletally mature patients with TPFs, reported at least one CT parameter predictive of soft tissue injury, and used arthroscopy or open surgery as the diagnostic gold standard. A risk of bias assessment was conducted using the Quality Assessment of Diagnostic Accuracy Studies 2 tool, and meta-analyses were performed where appropriate, using the random-effects model.
RESULTS
Lateral plateau depression (LPD) and lateral plateau widening (LPW) were the most commonly assessed parameters. Pooled analysis revealed that LPD and LPW were significantly higher in patients with lateral meniscus injuries (mean difference, 5.23 mm and 1.37 mm, respectively; P < 0.00001 and P = 0.02). No significant associations were found for medial plateau depression or LPD with medial meniscus or posterior cruciate ligament injuries. Lateral area of depression and LPW were reported in a single study to be predictive of anterior cruciate ligament injuries.
CONCLUSION
Preoperative CT parameters, particularly LPD and LPW, provide a strong predictive value for lateral meniscus injuries in TPFs, potentially aiding in early diagnosis and management. However, their utility in predicting cruciate or medial meniscus injuries remains limited. CT scan remains a valuable first-line tool, especially where magnetic resonance imaging is inaccessible, and can guide further investigation or intraoperative planning.
Core Tip: Although magnetic resonance imaging remains the gold standard for detecting meniscal and ligamentous injuries, it may not always be available in the acute trauma setting. This systematic review examined the predictive value of preoperative quantitative computed tomography scan parameters in identifying associated meniscal and cruciate ligament injuries in patients with tibial plateau fractures. Lateral plateau depression and widening were significantly greater in cases with lateral meniscus tears, confirming their diagnostic relevance. In contrast, medial plateau parameters and cruciate ligament correlations showed inconsistent predictive value. Preoperative computed tomography scans can provide valuable information beyond fracture characterization, offering indirect clues to concomitant soft-tissue injuries - particularly lateral meniscus.
