Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation (ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty (TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed.

Level IV.

This study was conducted to evaluate whether preoperative magnetic resonance imaging (MRI) measurements of the cross-sectional area and length of the semitendinosus tendon correlated with graft diameter. The goal of the study was to identify tendons at risk for requiring graft augmentation. The records of 140 consecutive patients undergoing anterior cruciate ligament (ACL) reconstruction between 2013 and 2016 were examined retrospectively. The study included 39 patients who underwent all-inside ACL reconstruction with a semitendinosus autograft. A single researcher used preoperative MRI scans to measure the cross-sectional area and length of the semitendinosus tendon. Graft cross-sectional area was correlated with semitendinosus tendon cross-sectional area with Pear-son's coefficients of 0.50 (95% confidence interval [CI], 0.21-0.70; P=.0013) and 0.59 (95% CI, 0.34-0.76; P=.0001) when measured under 2× and 4× magnification, respectively. In addition, MRI measurements of semitendinosus tendon length were correlated with both intraoperatively measured tendon length (r=0.75; 95% CI, 0.40-0.91; P=.0008) and graft diameter (r=0.43; 95% CI, 0.14-0.66; P=.0058). Average semitendinosus tendon cross-sectional area was 3.10 mm (95% CI, 0.53-5.67; P=.024) greater and semitendinosus tendon length was 14.05 mm (95% CI, 1.25-26.85; P=.035) greater in cases that did not require graft augmentation. Semitendinosus tendons with cross-sectional area of less than 13.2 mm or length of less than 81 mm are most likely to require graft augmentation. In addition, MRI measurements of the length and cross-sectional area of the semitendinosus tendon are significantly correlated with ACL graft diameter and could help to identify patients who may require graft augmentation. [Orthopedics. 2017; 40(4):e617-e622.].

The interactions between physicians and industry are necessary for advancement of clinical practice and improvement in medical devices. Physician-industry relationships also introduces financial conflicts of interest into research publications. Payments to physicians do not inherently introduce bias in research, but failure to disclose potential conflicts of interest can negatively impact the perceived integrity of authors, editors, and journals. The conflict of interest disclosure statement in all articles published in the Journal of the American Academy of Orthopaedic Surgery between 2014 and 2018 were compared to the financial payments indexed in the Center for Open Payments Database. Payment type, magnitude, and payer were obtained for each payment meeting inclusion criteria. Statistical comparisons were made using Mann-Whitney comparisons due to non-normal distribution of payment amounts.704 articles involving 2596 authors were reviewed, with 1268 authors meeting inclusion criteria. 634 authors had accurate disclosure statements. The total amount of disclosed payments was $169 million, whereas undisclosed payments were $14.2 million. The amount of disclosed payments on a per-author basis, $55,844 ($12,559, $186,129), was significantly greater than undisclosed payments, $2,171 ($568, $7,238). The lowest rates of correct disclosure were in education (29.2%), gifts (38.7%) and honoraria (57.8%). First and middle authors disclosed correctly at a significantly lower rate than last authors.The magnitude of undisclosed payments was significantly lower than disclosed payments, indicating that these payments do not register with authors as significant enough to disclose.