Second-look arthroscopy after surgical treatment of Schatzker type II plateau fractures through the lateral submeniscal approach

Clinical and radiographic results after arthroscopic repair of lateral meniscus tear in lateral-depression tibial plateau fracture

INTRODUCTION

To evaluate the clinical and radiographic results of AR/IF and meniscus repair for treating lateral meniscus (LM) tears associated with lateral tibial plateau fractures and to identify the factors associated with LM tear.

MATERIALS AND METHODS

Forty-two patients with lateral plateau fractures (Schatzker types II and III) treated by AR/IF were included retrospectively. Radiographic evaluations using the Rasmussen system and computerized tomography (CT) were performed. Clinical evaluations were also conducted at final follow-up. Second-look arthroscopy was applied during metal removal.

RESULTS

All fractures were healed after 46.3 months of follow-up. The mean Tegner activity level was not decreased significantly, going from 7.1 ± 2.1 pre-injury to 6.6 ± 2.3 at final follow-up (p = 0.301). However, the amount of depression noted on CT imaging was significantly decreased from 8.9 mm ± 4.4 to 1.2 mm ± 1.3 (p = 0.000). The mean Rasmussen radiologic score at final follow-up was 14.5 ± 5.3 points. Osteoarthritis was progressed in six patients (14.3%). Twenty-five patients had concomitant LM tear, with 18 cases treated by repair and the remaining ones treated by partial meniscectomy. Preoperative joint depression (> 11 mm) was significantly associated with the risk of LM tear (p = 0.024; odds ratio (OR): 9.0, 95% confidence interval (CI): 1.018-79.545) and most of those lesions could be repaired (p = 0.001). Postoperatively, 16 repaired patients were evaluated by second-look arthroscopy; 15 had healed completely and one had healed partially.

CONCLUSION

LM tears are frequently combined with lateral tibial plateau fracture, especially in correlation with more than 11 mm of joint depression, though most of those lesions can be repaired at the time of fracture fixation. AR/IF with arthroscopic meniscus repair could achieve good clinical and radiographic outcomes when treating Schatzker types II and III tibial plateau fractures.

STUDY DESIGN

Level IV retrospective cohort study.

A sub-meniscal arthrotomy improves the medium-term patient outcome of tibial plateau fractures

PURPOSE

This trial was conducted to determine the medium-term functional outcome of displaced tibial plateau fracture patients treated with closed fluoroscopic assisted reduction and internal fixation (CRIF) versus patients treated with standard open reduction with sub-meniscal arthrotomy and internal fixation (ORIF).

METHODS

A prospective trial was conducted in adult patients with displaced AO/OTA 41 B and 41 C tibial plateau fractures. Patients were assigned to treatment based upon the standard treatment of the surgeon involved following the call schedule for the day, either CRIF or ORIF. Postoperative radiographs and CT were performed on all patients and patients were followed for a minimum of 2 years. Primary outcome measures were the KOOS, SMFA and SF-36.

RESULTS

Seventy patients were recruited with 2 year follow-up on 35 patients in the CRIF group and 27 patients in the ORIF group. Postoperative CT scans showed that reductions were better with the ORIF group especially in the posterolateral quadrant as compared to the CRIF group. The frequency of mal-reductions was higher in the CRIF group. The KOOS, at two years, showed that the CRIF had significantly less good outcomes in the subcategories of SPORT (p = 0.03) and QOL (p = 0.01) measurements.

CONCLUSIONS

ORIF with a sub-meniscal arthrotomy provides better quality reductions and better medium-term results as compared to CRIF for tibial plateau fractures. This may provide more long-term benefit from osteoarthritic symptoms in this patient group.

LEVEL OF EVIDENCE

Therapeutic, Level 2.

Tibial plateau fracture management: ARIF versus ORIF - clinical and radiological comparison

INTRODUCTION

Arthroscopy has enabled minimally invasive procedures to be developed to treat tibial plateau fracture. The aim of the present study was to assess and compare clinical and radiological results between arthroscopically assisted reduction and internal fixation (ARIF) and open reduction and internal fixation (ORIF) procedures. The study hypothesis was that, in selected tibial plateau fractures, ARIF provides (1) clinical results comparable to those of ORIF, and (2) satisfactory reduction and stable fixation.

MATERIAL AND METHOD

A retrospective multicenter study included adult patients with tibial plateau fracture (Schatzker I to III), over the period January 2010 to December 2014, enabling a minimum 2 years' follow-up. Clinical and radiological data (RoM, IKDC, HSS, Lysholm) were collected at 3, 6 and 12 months and at last follow-up. A total of 317 patients (317 fractures), aged 48±14 years (range, 18-82 years) were followed up for 38±23 months (range, 24-90 months), with 77 fractures (24%) in the ARIF group and 240 (76%) in the ORIF group.

RESULTS

Clinically, there were no significant inter-group differences for active flexion, passive or active extension or Lysholm and IKDC scores, with significant differences for HSS (ARIF: 74±29; ORIF: 70±31; p<0.01) and passive flexion (ARIF: 130±19° (range, 80-160°); ORIF: 130±15.965° (range, 60-140°); p<0.05). Radiologically, there were no significant inter-group differences for reduction quality, lower-limb mechanical axis or signs of osteoarthritis. There were no secondary displacements. There were 7 complications (7/77, 9%) in the ARIF group and 18 (18/240, 8%) in the ORIF group, and 6 surgical revisions for early infection (2 ARIF, 4 ORIF), with no significant inter-group differences.

DISCUSSION

The study hypothesis was confirmed: in Schatzker I-III fractures, ARIF provided clinical results comparable to those of ORIF, with satisfactory reduction and stable fixation. ARIF has its place in the treatment of tibial plateau subsidence and/or separation fracture.

LEVEL OF EVIDENCE

III, retrospective comparative study.

Arthroscopic Assessment of Cartilage Healing Status after Treatment of Tibial Plateau Fracture

BACKGROUND

There are a few reports on the healing status of the cartilage after the treatment of tibial plateau fracture. In this study, we analyzed the healing status of articular cartilage using second-look arthroscopy with clinical and radiological results from patient's in schatzker Type I, II, and III tibial plateau fracture.

MATERIALS AND METHODS

43 patients operated between January 2011 and December 2013 were included in this retrospective study. Radiological evaluation was performed by comparing simple radiographs from the preoperative, postoperative, and final followup period. Clinical evaluations were performed using the Knee Society Knee Score (KSKS) and the Knee Society Functional Score (KSFS). Moreover, second-look arthroscopic evaluation was performed during implant removal, and cartilage healing status was classified according to the International Cartilage Repair Society grading system (ICRS).

RESULTS

In all 43 patients, bony union was achieved with a mean duration of 13.7 weeks. The degree of cartilage healing was poor when the step-off was high (P = 0.016). Furthermore, even in cases with satisfactory step-off <2 mm, there was no case with complete cartilage healing. Between ICRS grade and clinical results, the respective Pearson coefficient for KSKS and KSFS were r = -0.62 and r = -0.59 indicating mean statistically significant negative correlations (P = 0.001).

CONCLUSION

Even though step off was reduced anatomically and clinical outcome was excellent or good, there was not always complete cartilage healing in a followup on second-look arthroscopy. Therefore, we focused on not only radiologic and clinical outcome but also the actual status of cartilage with second-look arthroscopy.

Comparison of outcome of ARIF and ORIF in the treatment of tibial plateau fractures

PURPOSE

The purpose of this study is to explore whether arthroscopically assisted reduction and internal fixation (ARIF) is superior to traditional open reduction and internal fixation (ORIF) in the treatment of tibial plateau fractures.

METHODS

Fifty-seven patients with tibial plateau fractures (Schatzker type I-IV) treated by ARIF or ORIF from 2010 to 2013 were included in this retrospective study. All patients received pre-operative radiographs and CT scans. The patients were divided into two groups (ARIF or ORIF). All had a minimum follow-up of 24 months and an average follow-up of 44.4 months. The clinical and radiographic outcomes were evaluated according to the Rasmussen and KSS scores.

RESULTS

There was no significant difference in KSS score or Rasmussen clinical score between the two groups. The average Rasmussen radiographic score was 14.1 (SD 2.4, range 10-18), for the ARIF group and 14.9 (SD 2.3, range 10-18) for the ORIF group (p < 0.05). Meniscal lesions were found in 12 knees in group ARIF.

CONCLUSIONS

Both ARIF and ORIF yielded satisfactory clinical results for the treatment of Schatzker I-IV tibial plateau fractures. ARIF led to better radiological results than ORIF. Concomitant intra-articular soft tissue lesions are common and can be addressed during ARIF.

LEVEL OF EVIDENCE

III.

Balloon tibioplasty for reduction of depressed tibial plateau fractures: Preliminary radiographic and clinical results

PURPOSE

In vitro studies have shown promising results for balloon-guided inflation tibioplasty. It was our hypothesis that this technique may be safe and effective for use in depressed lateral tibial plateau fracture.

METHODS

We performed a prospective study of all patients suffering from a depressed lateral tibial plateau fracture, managed in our institution with inflation tibioplasty and a resorbable calcium phosphate bone substitute injection, between January 2012 and December 2013. Twenty patients, mean age 54.3 ± 12. 8 years, suffering from a depressed lateral tibial plateau fracture (Schatzker type II and III) were included. We then aimed to evaluate at a minimum follow-up of one year: (1) the rate of complications, (2) the clinical outcome (Knee Injury and Osteoarthritis Outcome (KOO) and 12-Item Short Form Health Survey (SF-12) scores); and (3) the radiographic outcome (evaluated by CT-scan).

RESULTS

No peri-operative complications occurred. In one patient, calcium phosphate substitute was found in the infrapatellar fat pad on post-operative radiography with no clinical or radiographic consequences at one year. At one year after surgery, the KOO subscores were: Pain 80 (range 64-93), other symptoms 81.3 (69-93), daily living activities 81.9 (46-99), sport 65.83 (20-100), and quality of life 67.04 (31-100). The SF-12 activity component was 40.4 (28.6-52.2) and SF-12 mental component 47.71 (28 - 67.1). The mean depressed step-off of the lateral joint decreased from 10.7 ± 4.8 mm pre-operatively to 2.7 ± 1.7 mm post-operatively (p < 0.0001).

CONCLUSION

Our observations suggest that the use of balloon-guided inflation tibioplasty with injection of a resorbable bone substitute is safe, and results in a high rate of anatomic reduction and good clinical outcomes in patients with depressed tibial plateau fractures.

LEVEL OF EVIDENCE

Therapeutic Level IV.

Outcomes and second-look arthroscopic evaluation after combined arthroscopic treatment of tibial plateau and tibial eminence avulsion fractures: a 5-year minimal follow-up

Background

Tibial eminence avulsion fracture often co-occurs with tibial plateau fracture, which leads to difficult concomitant management. The value of simultaneous arthroscopy-assisted treatment continues to be debated despite its theoretical advantages. We describe a simple arthroscopic suture fixation technique and hypothesize that simultaneous treatment is beneficial.

Methods

Patients with a tibial eminence avulsion fracture and a concurrent tibial plateau fracture who underwent simultaneous arthroscopically assisted treatment between 2005 and 2008 were enrolled in this retrospective study. Second-look arthroscopic evaluation and Rasmussen scores of clinical and radiographic parameters were used to assess simultaneous treatment.

Results

Forty-one patients (41 knees) met the inclusion criteria. All 41 fractures were successfully united. All patients had side-to-side differences of less than 3 mm and negative findings in Lachman and pivot-shift tests at their final follow-up. The mean postoperative Rasmussen clinical score was 27.3 (range: 19–30), and the mean radiologic score was 16.5 (range: 12–18). Clinical and radiographic outcomes in 98 % of the patients were good or excellent. There were no complications directly associated with arthroscopy in any patient.

Conclusions

Simultaneous arthroscopic suture fixation of associated tibial eminence avulsion fracture did not interfere with the plates and screws used to stabilize the tibial plateau fracture. It gave the knee joint adequate stability, minimal surgical morbidity, and satisfactory radiographic and clinical outcomes in a minimum follow-up of 5 years and in the arthroscopic second-look assessments.

Arthroscopic management of proximal tibial fractures: technical note and case series presentation

Background and aims

The purpose of this article is to describe a new surgical method of arthroscopy assisted treatment of intraarticular proximal tibial fractures (ARIF – arthroscopic reduction and internal fixation), analyzing its efficiency and safety on a series of patients. Tibial plateau fractures affect the proximal tibial metaphyseal and articular surface, representing 1.2% of all fractures and up to 8% of all fractures in elderly.

Patients and method

Our case series consists of 6 patients with Schatzker types I-III tibial plateau fractures, treated in the Orthopedic and Traumatology Clinic of Cluj-Napoca from July 2012 to August 2014. Patients included in the study presented Schatzker type I-III tibial plateau fracture.

Results

The results obtained with the arthroscopic method were excellent in 5 cases (mean Rasmussen score 27.60 points) and good in 1 case (mean score 23.75). The radiological consolidation appeared after a mean of 12 weeks. No major complication was noted.

Conclusions

Diagnosis and treatment of associated lesions, shortening of hospitalization length and postoperative rehabilitation, but also the lower rate of complications, can make arthroscopic reduction and internal fixation the method of choice for the operative treatment of selected Schatzker I-III types of proximal tibial fractures.