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An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries.

ABSTRACT: High-energy anterior cruciate ligament (high-energy ACL) injury, occurring in high-energy rotatory trauma of the knee, can accompany a unique fracture pattern that involves depression of the slope of the posterolateral tibial plateau (PLTP). These injuries are challenging to manage due to the lack of a gold-standard arthroscopic procedure that addresses both ACL deficiency and depressed PLTP slope. In such injuries, a one-stage approach may be used to (1) reconstruct the ACL or (2) reduce and fix the avulsed tibial spine, while concomitantly performing an arthroscopy-assisted reduction of a PLTP fracture that restores the anatomic slope of the tibial plateau. To summarize, using combined arthroscopic and fluoroscopic visualization, a tibial tunnel reaching 1 cm distal to the depressed plateau fragment is created using a cannulated drill. The drill is used to punch up the depressed fragment to its anatomic location, restoring the original slope of the PLTP. The corrected slope is then fixed in situ using a press-fit fibular allograft to stabilize the corrected PLTP slope. Use of this minimally invasive arthroscopic technique to restore the PLTP slope may help prevent graft failure of the reconstructed ACL and improve patient outcomes.

SUBMITTER: Park JP

PROVIDER: S-EPMC7528215 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Tibial plateau fractures account for a small portion of all fractures; however, these fractures can pose a surgical challenge when occurring concomitantly with ligament injuries.The purpose of this study was to compare 2-year outcomes of soft tissue reconstruction with or without a concomitant tibial plateau fracture and open reduction internal fixation. We hypothesized that patients with a concomitant tibial plateau fracture at the time of soft tissue surgery would have inferior outcomes compared with patients without an associated tibial plateau fracture.Cohort study; Level of evidence, 3.Forty patients were included in this study: 8 in the fracture group and 32 in the matched control group. Inclusion criteria for the fracture group included patients who were at least 18 years old at the time of surgery and sustained a tibial plateau fracture and a concomitant injury of the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, or fibular collateral ligament in isolation or any combination of cruciate or collateral ligaments and who subsequently underwent isolated or combined ligament reconstruction. Patients were excluded if they underwent prior ipsilateral knee surgery, sustained additional bony injuries, or sustained an isolated extra-articular ligament injury at the time of injury. Each patient with a fracture was matched with 4 patients from a control group who had no evidence of a tibial plateau fracture but underwent the same soft tissue reconstruction procedure.Patients in the fracture group improved significantly from preoperatively to postoperatively with respect to Short Form-12 (P < .05) and Western Ontario and McMaster Universities Osteoarthritis Index total scores (P < .05). The Lysholm (P = .075) and Tegner scores (P = .086) also improved, although this was not statistically significant. Patients in the control group improved significantly from preoperatively to postoperatively across all measured scores. A comparison of the postoperative results between the 2 groups showed no statistically significant difference.The presence of a tibial plateau fracture in conjunction with a ligamentous knee injury did not have a negative effect on postoperative patient-reported outcomes. Patient-reported outcome scores after surgery in both the fracture and control groups improved beyond the minimally clinically important difference, indicating that the presence of a fracture did not detract from the outcomes observed in patients without fractures undergoing concomitant ligament reconstruction.

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An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries.

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