Predictive value of preoperative computed tomography parameters for meniscal and cruciate ligament injuries in tibial plateau fractures: Meta-analysis

Table 1 Characteristics of patients, fractures, and study structures

Ref.	Country	Type of study	Number of patients	Sex (male/female)	Age, mean ± SD (range)	Fracture classification (according to Schatzker classification)	Studied structures	Reported CT parameters	Reference procedure
Chang et al[3], 2018	China	Prospective	100	77/23	44.6 ± 13.28 (18 to 72)	4 type I, 33 type II, 12 type III, 20 type IV, 18 type V and 15 type VI	LM, MM, ACL, and PCL	LPD, LPW, MPD, MPW, LAD and MAD	Arthroscopy (performed after fracture fixation)
Salari et al[20], 2021	United States	Retrospective	70	49/21	45.1 ± 12.9	12 type I and 58 type II	LM	LPD	Sub-meniscal arthrotomy
Jain et al[12], 2020	United Kingdom	Retrospective	88	58/30	45.25 ± 16.5	1 type I, 50 type II, 19 type IV, and 18 type VI	LM and MM	LPD and LPW	Open surgery
Kim et al[21], 2022	South Korea	Retrospective	42	26/16	47.2 ± 9.6 (17 to 63)	39 type II and 3 type III	LM	LPD	Arthroscopy (the authors performed ARIF)
Liu et al[22], 2023	China	Retrospective	60	35/25	Injured: 45.8 ± 18.2; intact: 44.5 ± 16.5	60 type IV	LM	LPD and LPW	Open surgery
Pu et al[10], 2022	China	Prospective	296	174/122	44.9 ± 15.6; injured: 46.0 ± 16.0; intact: 43.8 ± 15.2	296 type II	LM	LPD and LPW	They performed both open surgery evaluation (mainly for the anterior horn and body of the LM) and arthroscopic assessment of the remaining soft tissue structures
Ringus et al[13], 2010	United States	Retrospective	85	50/35	45.0 ± 17.6 (8 to 85); injured: 40.9 ± 15.1 (20 to75); intact: 46.9 ± 18.5 (18 to 85)	2 type I, 21 type II, 9 type III, 1 type IV, 35 type V and 16 type VI	LM	LPD	Open surgery
Tang et al[8], 2017	Taiwan	Retrospective	132	60/72	45.7 ± 13.1 (18 to 75)	4 type I, 25 type II, 20 type III, 8 type IV, 52 type V and 23 type VI	LM	LPD and LPW	Arthroscopy (the authors performed ARIF
Thamyongkit et al[23], 2018	Thailand	Prospective	10	6/4	52.4 ± 12.5 (35 to 80)	1 type I, 1 type II, 3 type IV, 2 type V and 3 type VI	LM, MM, and PCL	LPD, LPW, MPD and MPW	Arthroscopy

CT: Computed tomography; MM: Medial meniscus; LM: Lateral meniscus; ACL: Anterior cruciate ligament injury; PCL: Posterior cruciate ligament; LPD: Lateral plateau depression; LPW: Lateral plateau widening; MPD: Medial plateau depression; MPW: Medial plateau widening; LAD: Lateral area of depression; MAD: Medial area of depression; ARIF: Arthroscopic-assisted internal fixation.

Table 2 Risk of bias assessment according to Quality Assessment of Diagnostic Accuracy Studies 2

Ref.	Risk of Bias				Applicability
	Patient selection	Index test	Reference standard	Flow and timing	Patient selection	Index test	Reference standard
Chang et al[3], 2018	Low	Low	Low	Unclear	Low	Low	Low
Salari et al[20], 2021	High	Low	Low	Unclear	Low	Low	Low
Jain et al[12], 2020	Low	Low	Low	Unclear	Low	Low	Low
Liu et al[22], 2023	High	Low	Low	Low	Low	Low	Low
Ringus et al[13], 2010	High	Low	Low	Unclear	Low	Low	Low
Kim et al[21], 2022	High	Low	Low	Unclear	Low	Low	Low
Thamyongkit et al[23], 2018	High	Unclear	Unclear	Unclear	Low	Low	Low
Pu et al[10], 2022	High	Low	Low	Unclear	Low	Low	Low
Tang et al[8], 2017	Unclear	Low	Low	High	Low	Low	Low

Table 3 Differences in the computed tomography scans parameters between injured and intact soft tissue structures

Ref.	LM		MM		ACL		PCL
	Injured	Intact	Injured	Intact	Injured	Intact	Injured	Intact
Chang et al[3], 2018	LPW: 7 ± 7.4 mm; LPD: 11 ± 7.9 mm; LAD: 433.7 ± 229.1 mm2; MPW: 0.1 ± 0.8 mm; MPD: 0.3 ± 1.5 mm; MAD: 9.9 ± 61 mm2	LPW: 4.6 ± 4.3 mm; LPD: 6 ± 6.3 mm; LAD: 258.6 ± 250.9 mm2; MPW: 0.2 ± 1 mm; MPD: 0.4 ± 1.5 mm; MAD: 20.5 ± 83.7 mm2	LPW: 5.9 ± 6.8 mm; LPD: 5.9 ± 6.8 mm; LAD: 366.8 ± 289 mm2; MPW: 0.4 ± 1.5 mm; MPD: 0.7 ± 1.8 mm; MAD: 15.4 ± 77.5 mm2	LPW: 5.1 ± 4.7 mm; LPD: 8.8 ± 7.6 mm; LAD: 203 ± 242.2 mm2; MPW: 0.1 ± 0.7 mm; MPD: 0.3 ± 1.4 mm; MAD: 15.7 ± 46.1 mm2	LPW: 5.9 ± 6.8 mm; LPD: 5.9 ± 6.8 mm; LAD: 203 ± 242.2 mm2; MPW: 0.4 ± 1.5 mm; MPD: 0.7 ± 1.8 mm; MAD: 15.7 ± 46.1 mm2	LPW: 5.1 ± 4.7 mm; LPD: 8.8 ± 7.6 mm; LAD: 366.8 ± 289 mm2; MPW: 0.1 ± 0.7 mm; MPD: 0.3 ± 1.4 mm; MAD: 15.4 ± 77.5 mm2	LPW: 4.7 ± 4.1 mm; LPD: 8 ± 9.8 mm; LAD: 252.79.7 mm2; MPW: 1.1 ± 2.4 mm; MPD: 0.4 ± 1.4 mm; MAD: 17.1 ± 54.2 mm2	LPW: 5.9 ± 5.6 mm; LPD: 8.4 ± 7.3 mm; LAD: 291.1 ± 30.3 mm2; MPW: 0.1 ± 0.4 mm; MPD: 0.3 ± 1.5 mm; MAD: 15.2 ± 75.6 mm2
Salari et al[20], 2021	LPD: 12.48 ± 7.17 mm	LPD: 6.4 ± 4.3 mm	NR	NR	NR	NR	NR	NR
Jain et al[12], 2020	NR	NR	NR	NR	NR	NR	NR	NR
Kim et al[21], 2022	NR	NR	NR	NR	NR	NR	NR	NR
Liu et al[22], 2023	LPD: 15.3 ± 3.5 mm; LPW: 9.4 ± 1.8 mm	LPD: 8.4 ± 3.4 mm; LPW: 6.9 ± 0.9 mm	NR	NR	NR	NR	NR	NR
Pu et al[10], 2022	LPW: 8 ± 1.4 mm; LPD: 14.8 ± 10.2 mm	LPW: 6.8 ± 1.6 mm; LPD: 9.3 ± 8.1 mm	NR	NR	NR	NR	NR	NR
Ringus et al[13], 2010	LPD: 15.9 ± 8.4 mm	LPD: 9.5 ± 6.7 mm	NR	NR	NR	NR	NR	NR
Tang et al[8], 2017	LPW: 2.9 ± 3.4 mm; LPD: 14.8 ± 10.2 mm	LPW: 3.5 ± 4.8 mm; LPD: 9.3 ± 8.1 mm	NR	NR	NR	NR	NR	NR
Thamyongkit et al[23], 2018	LPD: 5.36 ± 3.56 mm; MPD: 1.78 ± 2.24 mm	LPD: 1.33 ± 2.17 mm; MPD: 2.44 ± 0.89 mm	LPD: 2.93 ± 4.19 mm; MPD: 3.38 ± 1.22 mm	LPD: 3.62 ± 3.06 mm; MPD: 1.26 ± 1.49 mm	NR	NR	LPD: 3.32 ± 2.29 mm; MPD: 3.29 ± 0.43 mm2	LPD: 3.35 ± 3.83 mm; MPD: 1.82 ± 1.81 mm

LM: Lateral meniscus; MM: Medial meniscus; ACL: Anterior cruciate ligament injury; PCL: Posterior cruciate ligament; LPW: Lateral plateau widening; LPD: Lateral plateau depression; LAD: Lateral area of depression; MPW: Medial plateau widening; MPD: Medial plateau depression; MAD: Medial area of depression; NR: Not reported.

Table 4 Receiver operating characteristic and regression analysis as reported from the included studies

Ref.	ROC analysis (cut-off point, sensitivity, specificity, and AUC)	Regression analysis (OR, 95%CI)
Chang et al[3], 2018	LMi-LPW: 6.3 mm, 75.5%, 58.5%, 0.7; LMi-LAD: 112.9 mm2, 83.7%, 43.4%, 0.67; ACLi-LPW: 5.7 mm, 75.5%, 58.5%, 0.68; ACLi-LAD: 209.5 mm2, 66.7%, 65.5%, 0.66	LMi-LPD: 4.35 (1.86-10.17); ACLi-LPW: 9.22 (2.33-36.54); ACLi-LAD: 6.81 (1.8-25.76)
Salari et al[20], 2021	LMi-LPD: 4.3 mm, 100%, 29%, 0.75	NR
Jain et al[12], 2020	NR	LMi-LPW: 0.25 (0.06-1.05); LMi-LPD: 0.19 (0.04-0.97)
Kim et al[21], 2022	LMi-LPD: 10.62 mm, 40.4%, 94.12%, 0.678	LMi-LPD: 9 (1.018-79.545)
Liu et al[22], 2023	LMi-LPW: 7.9 mm, 75%, 90%, 0.897; LMi-LPD: 8.4 mm, 95%, 85%, 0.898	LMi-LPW: 6.25 (1.59-24.55); LMi-LPD: 1.52 (1.148-2.016)
Pu et al[10], 2022	LMi-LPW: 7.5 mm, 70%, 70.6%, 0.724; LMi-LPD: 7.9 mm, 95%, 58.5%, 0.818	NR
Ringus et al[13], 2010	LMi-LPD: 10 mm, 79%, 67%, 0.74	LMi-LPD: 7.89 (2.64-23.59)
Tang et al[8], 2017	LMi-LPD: 11 mm, 70.3%, 61.8%	NR
Thamyongkit et al[23], 2018	NR	NR

ROC: Receiver operating characteristic; AUC: Area under the curve; OR: Odds ratio; CI: Confidence interval; LMi: Lateral meniscus injury; LPW: Lateral plateau widening; LAD: Lateral area of depression; ACLi: Anterior cruciate ligament injury; LPD: Lateral plateau depression; NR: Not reported.

Table 5 Leave-one-out sensitivity analysis for the lateral plateau width in predicting lateral meniscus injury

Study omitted	Pooled MD (95%CI)	I2	Tau2	Conclusion
Overall analysis	1.37 (0.24-2.49)	84%	0.95	Original significant finding
Chang et al[3], 2018	1.18 (0.01-2.36)	86%	1.07	Effect remains significant while point estimate decreases slightly
Liu et al[22], 2023	0.95 (-0.17 to 2.07)	82%	0.79	Effect loses statistical significance (P > 0.05)
Pu et al[10], 2022	1.65 (0.22-3.08)	88%	1.43	Effect remains significant while point estimate increases
Tang et al[8], 2017	1.94 (1.33-2.55)	0%	0.00	Effect remains significant and heterogeneity is eliminated

MD: Mean difference; CI: Confidence interval.