Tibial Plateau Depression and Widening As Predictors of Meniscal and Ligamentous Injuries: A Systematic Review and Meta-Analysis Publisher



Javidmehr S ; Pashazadeh M P ; Ramezanpour M R ; Akbarzadeh A ; Behzadi B ; Laprade R F
Source: Knee Surgery and Related Research Published:2026

Abstract

Background: Tibial plateau fractures are complex knee injuries frequently accompanied by meniscal and ligamentous injuries. Although radiography and computed tomography (CT) are routinely used to evaluate fracture patterns, their ability to predict associated soft-tissue injuries has not been well established. This systematic review investigated the diagnostic value of tibial plateau depression and widening as radiographic predictors of meniscal and ligamentous injuries in patients with tibial plateau fractures. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020. MEDLINE, Scopus, Embase, and Web of Science were searched up to July 2025. Studies evaluating the association between tibial plateau depression or widening and meniscal or major ligamentous injuries (cruciate and collateral ligaments) in adults were included. Random-effects models were used to pool mean differences (MDs) and diagnostic accuracy estimates. Results: A total of 17 studies encompassing 1348 patients were included. Patients with lateral meniscus (LM) injuries had significantly greater lateral plateau depression (LPD) than those without (MD 5.03 mm, 95% CI 3.94–6.12). The pooled diagnostic odds ratio (DOR) of LPD for detecting LM injury was 9.80, with a sensitivity of 84%, specificity of 63%, and an area under the sROC curve (AUC) of 0.724. Lateral plateau widening (LPW) was also significantly higher in patients with LM injuries (MD 1.37 mm, 95% CI 0.29–2.45), with a pooled DOR of 7.97, sensitivity of 71%, specificity of 71%, and AUC of 0.758. Associations between LPD/LPW and medial meniscus or cruciate ligament injuries were more heterogeneous, although LPD had consistent relationships with lateral collateral ligament injury and LPW showed a significant pooled association with anterior cruciate ligament (ACL) injury (MD = 3 mm). Conclusions: LPD was the most consistent radiographic predictor of LM injury, with injured patients demonstrating, on average, 5 mm greater depression, while LPW provided complementary value with a pooled MD of 1.37 mm in patients with LM injury and also showed a significant, though more heterogeneous, association with ACL injury. These routinely available CT- or radiograph-based parameters can help stratify the risk of soft-tissue injury and guide selective use of MRI or arthroscopic inspection with tibial plateau fractures. © The Author(s) 2026.