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Immediate arthroscopy following ORIF for tibial plateau fractures provide early diagnosis and treatment of the combined intra-articular pathologies

  • Jae-Jung Jeong
  • Seung-bae Oh
  • Jong-Hun JiEmail author
  • Seok-Jae Park
  • Myung-Sup Ko
KNEE
  • 29 Downloads

Abstract

Purpose

To evaluate the effectiveness of immediate arthroscopy and clinical outcomes following open reduction and internal fixation (ORIF) of tibial plateau fractures.

Methods

Sixty patients (36 men and 24 women, median age 56 (20–78) years) were divided into Group I (ORIF only: 26 patients, median age 58 (25–78) years) or Group II (ORIF with immediate arthroscopy: 34 patients, median age 55 (20–75) years) in tibial plateau fractures (Schatzker Type II–VI fractures). In the first part of this study, ORIF only was performed without arthroscopic treatment. In the second part, ORIF with immediate arthroscopic examination and treatment was performed. Clinical outcomes, utilizing range of motion (ROM), International Knee Documentation Committee (IKDC) score and hospital for special knee score (HSS) were assessed.

Results

At the final follow-up, HSS score was 81 ± 11 points in Group I and 83 ± 9 points in Group II. The IKDC score was 85 ± 8 points in Group I and 86 ± 6 points in Group II. In Group II, concomitant intra-articular lesions in 10 patients (29%) were found and treated simultaneously. However, there were no significant differences in clinical scores or ROM between the two groups.

Conclusion

Immediate arthroscopy following ORIF for tibial plateau fracture is an effective procedure that provides accurate information for fracture reduction, leading to immediate treatment of concomitant intra-articular lesions without complications.

Level of evidence

III.

Keywords

Tibial plateau fracture Open reduction and internal fixation Immediate arthroscopy Intra-articular lesions 

Notes

Funding

No external funding was used.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Arnold JB, Tu CG, Phan TM, Rickman M, Varghese VD, Thewlis D, Solomon LB (2017) Characteristics of postoperative weight bearing and management protocols for tibial plateau fractures: findings from a scoping review. Injury 48(12):2634–2642CrossRefGoogle Scholar
  2. 2.
    Barenius B, Ponzer S, Shalabi A, Bujak R, Norlen L, Eriksson K (2014) Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial. Am J Sports Med 42(5):1049–1057CrossRefGoogle Scholar
  3. 3.
    Burdin G (2013) Arthroscopic management of tibial plateau fractures: surgical technique. Orthop Traumatol Surg Res 99(1 Suppl):S208–S218CrossRefGoogle Scholar
  4. 4.
    Chen XZ, Liu CG, Chen Y, Wang LQ, Zhu QZ, Lin P (2015) Arthroscopy-assisted surgery for tibial plateau fractures. Arthroscopy 31(1):143–153CrossRefGoogle Scholar
  5. 5.
    Chiu CH, Cheng CY, Tsai MC, Chang SS, Chen AC, Chen YJ, Chan YS (2013) Arthroscopy-assisted reduction of posteromedial tibial plateau fractures with buttress plate and cannulated screw construct. Arthroscopy 29(8):1346–1354CrossRefGoogle Scholar
  6. 6.
    Dejour H, Walch G, Deschamps G, Chambat P (2014) Arthrosis of the knee in chronic anterior laxity. Orthop Traumatol Surg Res 100(1):49–58CrossRefGoogle Scholar
  7. 7.
    Egol KA, Cantlon M, Fisher N, Broder K, Reisgo A (2017) Percutaneous repair of a Schatzker III Tibial plateau fracture assisted by arthroscopy. J Orthop Trauma 31(Suppl 3):S12–S13CrossRefGoogle Scholar
  8. 8.
    Gamulin A, Lubbeke A, Belinga P, Hoffmeyer P, Perneger TV, Zingg M, Cunningham G (2017) Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures: a retrospective cohort study. BMC Musculoskelet Disord 18(1):307CrossRefGoogle Scholar
  9. 9.
    Guanche CA, Markman AW (1993) Arthroscopic management of tibial plateau fractures. Arthroscopy 9(4):467–471CrossRefGoogle Scholar
  10. 10.
    Hegenscheid K, Puls R, Rosenberg C (2012) Imaging strategies for knee injuries. Radiologe 52(11):980–986CrossRefGoogle Scholar
  11. 11.
    Hohl MLR (1991) Fractures of the knee. In: Rockwood CA Jr, Green DP, Bucholz RW (eds) Fractures in adults, vol 2. JB Lippincott, Philadelphia, pp 1725–1757Google Scholar
  12. 12.
    Krause M, Preiss A, Meenen NM, Madert J, Frosch KH (2016) “Fracturoscopy” is superior to fluoroscopy in the articular reconstruction of complex Tibial Plateau fractures—an arthroscopy assisted fracture reduction technique. J Orthop Trauma 30(8):437–444CrossRefGoogle Scholar
  13. 13.
    Li JW, Ye F, Bi DW, Zheng XD, Chen JL (2018) Treatment of Schatzker IV tibial plateau fractures with arthroscopy combined with MIPPO technique. Zhongguo Gu Shang 31(2):186–189Google Scholar
  14. 14.
    Liao W, Li Z, Zhang H, Li J, Wang K, Yang Y (2016) Arthroscopic fixation of tibial eminence fractures: a clinical comparative study of nonabsorbable sutures versus absorbable suture anchors. Arthroscopy 32(8):1639–1650CrossRefGoogle Scholar
  15. 15.
    Madelaine A, Fournier G, Sappey-Marinier E, Madelaine T, Seil R, Lefevre N, Chotel F (2018) Conservative management of anterior cruciate ligament injury in paediatric population: about 53 patients. Orthop Traumatol Surg Res 104(8S):S169–S173CrossRefGoogle Scholar
  16. 16.
    Markhardt BK, Gross JM, Monu JU (2009) Schatzker classification of tibial plateau fractures: use of CT and MR imaging improves assessment. Radiographics 29(2):585–597CrossRefGoogle Scholar
  17. 17.
    Mayr HO, Stoehr A (2016) Complications of knee arthroscopy. Orthopade 45(1):4–12CrossRefGoogle Scholar
  18. 18.
    McNamara IR, Smith TO, Shepherd KL, Clark AB, Nielsen DM, Donell S, Hing CB (2015) Surgical fixation methods for tibial plateau fractures. Cochrane Database Syst Rev 9:CD009679Google Scholar
  19. 19.
    Mellema JJ, Doornberg JN, Molenaars RJ, Ring D, Kloen P (2016) Tibial plateau fracture characteristics: reliability and diagnostic accuracy. J Orthop Trauma 30(5):e144–e151CrossRefGoogle Scholar
  20. 20.
    Mendel T, Wohlrab D, Hofmann GO (2011) Acute compartment syndrome of the lower leg due to knee arthroscopy. Orthopade 40(10):925–928CrossRefGoogle Scholar
  21. 21.
    Mthethwa J, Chikate A (2017) A review of the management of tibial plateau fractures. Musculoskelet Surg 102:119–127CrossRefGoogle Scholar
  22. 22.
    Padanilam TG, Ebraheim NA, Frogameni A (1995) Meniscal detachment to approach lateral tibial plateau fractures. Clin Orthop Relat Res 314:192–198Google Scholar
  23. 23.
    Paterno MV (2017) Non-operative care of the patient with an ACL-deficient knee. Curr Rev Musculoskelet Med 10(3):322–327CrossRefGoogle Scholar
  24. 24.
    Patil SS, Shekhar A, Tapasvi SR (2017) Meniscal preservation is important for the knee joint. Indian J Orthop 51(5):576–587CrossRefGoogle Scholar
  25. 25.
    Pitta GB, Dos Santos TF, Dos Santos FT, da Costa Filho EM (2014) Compartment syndrome after tibial plateau fracture. Rev Bras Ortop 49(1):86–88CrossRefGoogle Scholar
  26. 26.
    Sanders TL, Pareek A, Barrett IJ, Kremers HM, Bryan AJ, Stuart MJ, Levy BA, Krych AJ (2017) Incidence and long-term follow-up of isolated posterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc 25(10):3017–3023CrossRefGoogle Scholar
  27. 27.
    Sanders TL, Pareek A, Kremers HM, Bryan AJ, Levy BA, Stuart MJ, Dahm DL, Krych AJ (2017) Long-term follow-up of isolated ACL tears treated without ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 25(2):493–500CrossRefGoogle Scholar
  28. 28.
    Thabet AM, Simson JE, Gerzina C, Dabash S, Adler A, Abdelgawad AA (2018) The impact of acute compartment syndrome on the outcome of tibia plateau fracture. Eur J Orthop Surg Traumatol 28(1):85–93CrossRefGoogle Scholar
  29. 29.
    Wang PC, Ren D, Zhou B (2015) Surgical technique of anterolateral approach for Tibial Plateau fracture. Orthop Surg 7(4):368–370CrossRefGoogle Scholar
  30. 30.
    Weinlein J, Schmidt A (2010) Acute compartment syndrome in tibial plateau fractures–beware! J Knee Surg 23(1):9–16CrossRefGoogle Scholar
  31. 31.
    Zeltser DW, Leopold SS (2013) Classifications in brief: Schatzker classification of tibial plateau fractures. Clin Orthop Relat Res 471(2):371–374CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopedic Surgery, Daejeon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaDaejeonRepublic of Korea

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