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Long-term outcome after surgical treatment of intra-articular tibial plateau fractures in skiers

  • Trauma Surgery
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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Tibial plateau fractures occur frequently during downhill skiing. There is a lack of information about the outcome and development of posttraumatic osteoarthritis after internal fixation of such fractures at long-term follow-up in skiers.

Materials and methods

A population of 83 skiers was followed up in a case series after internal fixation of intra-articular tibial plateau fractures AO-OTA 41 B1-B3 and C1-C3. Functional outcomes Visual Analog Scale, Tegner Activity Scale, Modified Lysholm Score, Hospital for Special Surgery (HSS) Knee Score and X-ray images of the affected knees (preoperative, postoperative and at time of follow-up) were obtained. Radiological evaluation focused on severity of osteoarthritis according to the Kellgren and Lawrence score of the lateral, medial and retropatellar knee compartments separately. Subgroup analyses for fracture type and age were performed separately.

Results

Patients age was 49.8 ± 12.9 years (range 19–74 years) at the time of surgery, with a mean follow-up period of 10.3 ± 1.9 years (range 6–14 years). All tibial plateau fractures affected the lateral compartment, while the medial compartment was affected in addition as part of bicondylar fractures in two cases. Both the Tegener Activity Scale and Lysholm Score decreased significantly during the follow-up period and their median values dropped from 6 (range 3–7) to 5 (range 2–7) and from 100 (range 90–100) to 95 (range 58–100), respectively (both p < .01). The median clinical knee function at the time of follow-up revealed an HSS Knee Score of 96.5 points (range 74–100). Among the whole patient population, the radiological evaluation at follow-up revealed a significantly higher grade of osteoarthritis in all compartments of the knee joint compared to the time of the operation (p < .01). The grade of osteoarthritis in the lateral compartment was significantly higher than that in the medial and retropatellar compartments (p < .01).

Conclusions

In addition to physiologic aging, progression of radiologic signs of osteoarthritis following internal fixation of intra-articular tibial plateau fractures in an athletic population of skiers is most severe in the lateral knee compartment corresponding to fracture location. However, the long-term functional outcomes seem to be very satisfactory.

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Acknowledgments

The authors thank all their patients for the participation and the staff of the Davos Hospital for support of this study.

Funding

There is no funding source.

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Authors and Affiliations

  1. Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldinger Str., 35043, Marburg, Germany

    Martin Bäumlein

  2. Department of Trauma Surgery, Davos Hospital, Davos, Switzerland

    Martin Bäumlein, Thomas Perren, Paavo Rillmann, Christian Ryf & Markus Loibl

  3. Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany

    Alexander Hanke, Michael Nerlich & Markus Loibl

  4. AO Research Institute Davos, Davos, Switzerland

    Boyko Gueorguiev

  5. Trauma Department, Hannover Medical School (MHH), Hannover, Germany

    Emmanouil Liodakis

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  1. Martin Bäumlein
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Correspondence to Martin Bäumlein.

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The study was approved by the institutional review board.

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Informed consent was obtained from all individual participants included in the study in accordance with the declaration of Helsinki.

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Bäumlein, M., Hanke, A., Gueorguiev, B. et al. Long-term outcome after surgical treatment of intra-articular tibial plateau fractures in skiers. Arch Orthop Trauma Surg 139, 951–959 (2019). https://doi.org/10.1007/s00402-019-03150-6

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