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Objective <p>To systematically evaluate the incidence, characteristics, and patterns of associated ligamentous and soft-tissue injuries in hyperextension tibial plateau fractures (HTPFs) using magnetic resonance imaging (MRI).</p> Methods <p>We retrospectively analyzed data from 48 patients diagnosed with HTPFs at our hospital between January 2019 and October 2025. Patients with complete radiographic, computed tomography (CT), and magnetic resonance imaging (MRI) data were included. MRI was utilized to evaluate injuries to menisci, collateral ligaments, cruciate ligaments, the posterolateral corner (PLC), popliteus tendon/muscle, and the patellar ligament. Statistical analyses included Chi-square and Fisher’s exact tests, with significance set at <i>P</i> &lt; 0.05.</p> Results <p>Among the 48 patients included in the analysis (26 men and 22 women; mean age, 51.3 ± 13.7&#xa0;years), associated soft-tissue injuries were identified in 43 patients (89.6%). Anterior cruciate ligament (ACL) injuries (60%) and posterolateral corner (PLC) injuries (75%) were the most frequently observed. Patients were categorized into two groups: Group 1, hyperextension–varus fractures (<i>n</i> = 18), and Group 2, hyperextension–valgus fractures (<i>n</i> = 27). Hyperextension–varus fractures demonstrated a significantly higher incidence of fibular head avulsion fractures compared with hyperextension–valgus fractures (56% vs. 4%, <i>P</i> = 0.01). No statistically significant differences were observed between the two groups with respect to other ligamentous injuries. Given the relatively small sample size of the present study, these results should be interpreted with caution.</p> Conclusion <p>HTPFs frequently involve concomitant ligamentous and soft-tissue injuries, particularly affecting the ACL and PLC. Fibular head avulsion fractures were notably prevalent in hyperextension–varus fracture subtypes. Comprehensive preoperative imaging, including MRI, is critical for accurate diagnosis, surgical planning, and optimizing functional outcomes.</p> Level of Evidence <p>Diagnostic level Ⅲ.</p>

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Ligamentous and Soft-Tissue Injury Patterns in Hyperextension Tibial Plateau Fractures: An MRI-Based Analysis of Varus and Valgus Subtypes

  • 期刊论文

  • 发表日期：

    2026年3月13日

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  • Xiaodong Xie,
  • Lihua Ma,
  • Yu Zhang,
  • Peng Chen,
  • Lingbin Wang,
  • Heng Xu

摘要

Objective

To systematically evaluate the incidence, characteristics, and patterns of associated ligamentous and soft-tissue injuries in hyperextension tibial plateau fractures (HTPFs) using magnetic resonance imaging (MRI).

Methods

We retrospectively analyzed data from 48 patients diagnosed with HTPFs at our hospital between January 2019 and October 2025. Patients with complete radiographic, computed tomography (CT), and magnetic resonance imaging (MRI) data were included. MRI was utilized to evaluate injuries to menisci, collateral ligaments, cruciate ligaments, the posterolateral corner (PLC), popliteus tendon/muscle, and the patellar ligament. Statistical analyses included Chi-square and Fisher’s exact tests, with significance set at P < 0.05.

Results

Among the 48 patients included in the analysis (26 men and 22 women; mean age, 51.3 ± 13.7 years), associated soft-tissue injuries were identified in 43 patients (89.6%). Anterior cruciate ligament (ACL) injuries (60%) and posterolateral corner (PLC) injuries (75%) were the most frequently observed. Patients were categorized into two groups: Group 1, hyperextension–varus fractures (n = 18), and Group 2, hyperextension–valgus fractures (n = 27). Hyperextension–varus fractures demonstrated a significantly higher incidence of fibular head avulsion fractures compared with hyperextension–valgus fractures (56% vs. 4%, P = 0.01). No statistically significant differences were observed between the two groups with respect to other ligamentous injuries. Given the relatively small sample size of the present study, these results should be interpreted with caution.

Conclusion

HTPFs frequently involve concomitant ligamentous and soft-tissue injuries, particularly affecting the ACL and PLC. Fibular head avulsion fractures were notably prevalent in hyperextension–varus fracture subtypes. Comprehensive preoperative imaging, including MRI, is critical for accurate diagnosis, surgical planning, and optimizing functional outcomes.

Level of Evidence

Diagnostic level Ⅲ.