Medial tibial plateau fracture-dislocations associated with posterolateral central depression exhibit radiologic ACL-type pivoting injury pattern

Objectives To determine whether medial tibial plateau fracture-dislocations with posterolateral central depression demonstrate radiographic features consistent with an ACL-type anterolateral rotatory injury pattern, characterized by anterior tibial translation and internal rotation. Methods Retrospective radiologic evaluation of adult patients who underwent surgery for medial plateau fracture-dislocation with associated posterolateral central depression. Only patients with both preoperative computed tomography (CT) and magnetic resonance imaging (MRI) were included. Imaging was assessed for features associated with anterolateral tibiofemoral rotational injuries, including pivot-shift edema, anterior subluxation of the lateral compartment, tibial eminence fractures, meniscal pathology (root and intrasubstance tears), and Segond fractures. Two independent dual fellowship-trained sports traumatology orthopaedic surgeons reviewed all imaging. Categorical variables were reported as proportions and continuous variables as means with standard deviations. Institutional research ethics board approval was obtained. Results Eighteen patients met inclusion criteria. The mean age was 37 (± 11) years, and 72% were male. Pivot-shift femoral edema, anterior subluxation of the lateral compartment on MRI, tibial eminence fracture at the ACL footprint, and posterolateral central tibial depression were present in all cases (18/18, 100%). Lateral meniscal root pathology was also universal, with lateral meniscus incarceration into the posterolateral depression observed in eight patients (44%). A Segond fracture was identified in nine patients (50%). Conclusion Medial tibial plateau fracture-dislocations with posterolateral central depression demonstrate a consistent pattern of osseous and soft-tissue injury associated with anterolateral rotation. These findings suggest that transverse plane assessment may complement traditional fracture based evaluation and help identify associated soft-tissue injuries that may be important to tibiofemoral stability.