An evaluation of meniscus tears in lateral tibial plateau fractures and repair results

Tekin, Ali Çağrı; Çakar, Murat; Esenyel, Cem Zeki; Adaş, Müjdat; Bayraktar, Mehmet Kürşad; Özcan, Yusuf; Saygılı, Mehmet Selçuk; Tekin, Zeynep Nilüfer

doi:10.3233/bmr-160698

Cited by 12 publications

(9 citation statements)

References 24 publications

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“…Through literature review, the advantages of the extended anterolateral approach are as follows: the patient can be in the supine position; exposure of the lateral, posterior, and platform surface of the tibia is relatively clear, and sufficient operation space exists; neurovascular injury and fibular head osteotomy are avoided, and damage to the original anatomical structure is small; in anterolateral column and posterolateral column fractures, this approach can be used alone for fracture reduction and plate fixation; the learning curve is relatively simple compared with that of the posterior approach. [ 20 , 21 ] Previous studies using the extended anterolateral approach to treat posterolateral tibial plateau column fractures have achieved good clinical results. Chen et al, [ 22 ] in the last follow-up of 10 patients, revealed an average HHS score of 95.3 ± 6.5 points (range: 80–100 points), an average knee flexion of 119.8 ± 17.2° (range: 95°–140°) and an average knee extension of 2.1 ± 2.1° (range: 0°–6°).…”

Section: Discussionmentioning

confidence: 99%

Treatment of tibial plateau fractures involving the posterolateral column using the extended anterolateral approach

et al. 2021

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To summarize the surgical technique and clinical effects of the extended anterolateral approach for the treatment of Schatzker type II and Schatzker type V/VI involving the posterolateral column tibial plateau. From January 2015 through December 2018, 28 patients with tibial plateau fractures involving the posterolateral column were included in the study. Among them, 16 patients were Schatzker type II treated using an extended anterolateral approach with lateral tibial locking compression plate fixation. Twelve patients were Schatzker type V or VI treated using an extended anterolateral combined with a medial approach using lateral tibial locking compression plate plus medial locking compression plate fixation. All cases were followed up for 15 to 31 months, with an average follow-up of 22.5 ± 3.7 months. During the follow-up, the tibial plateau angle (TPA), lateral posterior angle (PA) and Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation; the Hospital for Special Knee Surgery score and the range of motion were used to evaluate knee function. Additionally, the Lachman and knee Valgus (Varus) stress tests were used to evaluate anteroposterior and lateral stability of the knee. All fractures healed. At the 12-month follow-up, the Schatzker type II group revealed a mean TPA of 86.38 ± 3.92°, a mean PA of 7.43 ± 2.68°, and a mean Rasmussen radiological score of 16.00 ± 2.06 points. The Schatzker type V/VI group showed a mean TPA of 84.91 ± 3.51°, a mean PA of 9.68 ± 4.01°, and a mean Rasmussen radiological score of 15.33 ± 2.99 points. During the 1-year follow-up, when the postoperative PA was re-measured, the TPA and Rasmussen score of the 2 groups did not change significantly ( P > .05). At the last follow-up, the Schatzker type II group showed a knee flexion angle of 110° to 135° and a mean HHS score of 88.37 ± 10.01 points. The Schatzker type V/VI group revealed a knee flexion angle of 100° to 130° and a mean HHS score of 82.17 ± 10.76 points. Additionally, up to the last follow-up, the Lachman and knee Valgus (Varus) stress test results of the 2 groups were negative. No complications were found. The extended anterolateral approach is a good choice to treat tibial plateau fractures involving the posterolateral column.

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Section: Discussionmentioning

confidence: 99%

Treatment of tibial plateau fractures involving the posterolateral column using the extended anterolateral approach

et al. 2021

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“…nevertheless, it is di cult to expose and x the posterior tibial plateau through traditional anterolateral approach. Through literature review, the advantages of the extended anterolateral approach are as follows: the patient can be in the supine position; the exposure of the lateral, posterior and platform surface of the tibia is relatively clear, and there is enough operation space; the neurovascular injury and bular head osteotomy are avoided to a large extent, and the damage to the original anatomical structure is small; In anterolateral column and posterolateral column fractures, this approach can be used alone for fracture reduction and plate xation; the learning curve is relatively simple compared with the posterior approach [18,19]. Previous studies through the extended anterolateral approach for the treatment of posterolateral tibial plateau column fractures have achieved good clinical results.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Tibial Plateau Fractures Involving Posterolateral Column Through the Extended Anterolateral Approach

Mao

Chen

et al. 2021

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ObjectiveTo summarize the surgical technique and the clinical effects of extended anterolateral approach for the treatment of Schatzker type II and Schatzker type V/VI which involving the posterolateral column tibial plateau.MethodsFrom January 2015 through December 2018, a total of 28 patients with tibial plateau fracture involving posterolateral column were included in this study. Among them, 16 patients were Schatzker type II treated via extended anterolateral approach with lateral tibial locking compression plate fixation.12 patients were Schatzker type V or VI treated via extended anterolateral combine with medial approach by lateral tibial locking compression plate plus medial locking compression plate fixation. All cases were followed up for 15~31 months, with an average follow‐up of 22.5±3.7 months. During the follow-up, the tibial plateau angle (TPA), lateral posterior angle (PA) and Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation; the Hospital for Special Surgery (HSS) and the range of motion were used to evaluate knee function; the Lachman and knee Valgus (Varus) stress test were used to evaluate anteroposterior and lateral stability of the knee.ResultsAll fractures healed. At the 12-month follow-up: in Schatzker type II group a mean TPA of 86.38±3.92°, a mean PA of 7.43±2.68°, and Rasmussen radiological score with an average of 16.00±2.06 points, scores were excellent in 6 cases and good in 10 cases, as a result the excellent and good rate was 100%; while in in Schatzker type V/VI group a mean TPA of 84.91±3.51°, a mean PA of 9.68±4.01°, and Rasmussen radiological score with an average of 15.33±2.99 points, scores were excellent in 4 cases and good in 6 cases, as a result the excellent and good rate was 83.33%. During the one-year follow-up, when re-measured postoperative PA, TPA, Rasmussen score of the two groups did not change significantly (P > 0.05). At the last follow‐up, in Schatzker type II group, the the knee flexion angle was 110° ~135°, with an average of 125°±8.56°,a mean of HHS score 88.37±10.01 points, scores were excellent in 9 cases and good in 5 cases, as a result the excellent and good rate was 100%; in Schatzker type V/VI group, the the knee flexion angle was 100° ~130°, with an average of 120°±11.25°,a mean of HHS score 82.17±10.76 points, scores were excellent in 5 cases and good in 3 cases, as a result the excellent and good rate was 66,67%.In addition, up to the last follow-up, Lachman and knee Valgus (Varus) stress test results of the two groups were negative. No complications were found.ConclusionsAlthough there are many ways to treat posterolateral tibial plateau fractures, When choosing one or more combined approach, we must consider the condition of soft tissue injury, the shape of the whole platform fracture including the posterolateral bone block and the available fixation methods. The best approaches should provide maximum exposure of the platform, enough space for reduction and fixation, and minimum damage to the surrounding structures. For anterolateral platform fractures combine with isolated posterolateral fracture fragments, the extended anterolateral approach is more suitable as a single approach. For multiple column tibial plateau fractures a dual approach (extended anterolateral combined with medial approach) can be used to enter the whole plateau area.

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“…Lateral meniscus injuries have a dramatic impact on the risk of an osteoarthritis of the knee and are often undiagnosed and nonaddressed. 30,31 A major advantage of the described method would therefore certainly be the simultaneous easy treatment of a potential meniscus pathology during further preparation. A proper indication for a central subluxation of the lateral meniscus are intra-articular comminuted tibial plateau fractures with central and/or dorsal fracture lines involving the lateral tibial plateau, especially affecting the posterolaterolateral and/or the posterolaterocentral segment, with not sufficient visualization despite submeniscal approach.…”

Section: Discussionmentioning

confidence: 99%

Improved Visualization by Central Subluxation of the Lateral Meniscus in Comminuted Lateral Tibial Plateau Fractures

et al. 2020

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The goal of surgical reconstruction of comminuted tibial plateau fractures is an anatomical reconstruction and stable fixation of the articular surface. This can be difficult due to poor visualization of the posterolateral and central segments of the articular surface of the proximal tibia. To improve visualization, the lateral approach can be extended with an osteotomy of the femoral epicondyle. In most cases, use of the extended lateral approach allows the whole lateral plateau to be visualized. Nevertheless, in some cases, an osteotomy alone is not enough to expose the entire fracture, especially the central segments of the tibial plateau. For these specific cases, we developed an additional technical trick that significantly improves articular visualization; the lateral meniscocapsular fibers are dissected allowing for central subluxation of the lateral meniscus, while leaving the anterior and posterior roots intact. With central subluxation of the lateral meniscus in comminuted tibial plateau fractures, the joint surface can be completely visualized, allowing an anatomical reduction even in highly complex fractures.

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An evaluation of meniscus tears in lateral tibial plateau fractures and repair results

Abstract: For successful outcomes in lateral plateau fractures, it is essential to determine whether there is a meniscus tear. In cases with meniscus tears, meniscus repair can be easily performed and should be considered because it has a positive impact on the treatment outcome.

Cited by 12 publications

References 24 publications

Treatment of tibial plateau fractures involving the posterolateral column using the extended anterolateral approach

Treatment of tibial plateau fractures involving the posterolateral column using the extended anterolateral approach

Treatment of Tibial Plateau Fractures Involving Posterolateral Column Through the Extended Anterolateral Approach

Improved Visualization by Central Subluxation of the Lateral Meniscus in Comminuted Lateral Tibial Plateau Fractures

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