Incidence, Risk Factors, and Location of Articular Malreductions of the Tibial Plateau

Meulenkamp, Brad; Martin, Ryan; Desy, Nicholas M.; Duffy, Paul; Korley, R; Puloski, Shannon; Buckley, Richard

doi:10.1097/bot.0000000000000735

Cited by 71 publications

(64 citation statements)

References 25 publications

(24 reference statements)

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“…14 We previously identified a 32.3% rate of lateral tibial plateau articular malreduction (> 2 mm step or gap). 8 In this study, a striking 77% of articular malreductions were mapped to the PLTP (►Fig. 1), further emphasizing the difficulty of obtaining and maintaining an anatomic reduction in this area.…”

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confidence: 74%

“…In general, surgical goals of tibial plateau fracture open reduction and internal fixation (ORIF) are to restore stability and function by recreating articular congruity, coronal and sagittal alignment, and condylar width. [7][8][9] Articular malreduction of tibial plateau fractures is a common and undesirable outcome of ORIF. For example, in a series of bicondylar tibial plateau fractures, Barei et al identified a 45% articular malreduction rate (defined as > 2 mm step or gap) which was associated with an inferior functional outcome in those patients.…”

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confidence: 99%

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VIS-IT: Visualizing the Injured Tibia—A Cadaveric Study of Limb Positioning for Posterolateral Tibial Plateau Fracture Visualization

et al. 2019

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Posterolateral tibial plateau (PLTP) fractures are often associated with anterior cruciate ligament (ACL) incompetence, such as tibial eminence fractures. Both occur from a pivot shift like mechanism. Malreductions of the tibial plateau most frequently occur in the posterolateral quadrant. Acquiring adequate intraoperative visualization of the PLTP poses a challenge. We hypothesized that visualization of PLTP could be improved by positioning the knee at 110 degrees of flexion with the addition of a varus anterolateral rotatory vector. This position and maneuver take advantage of both the nonisometric nature of the lateral soft tissues and, when present, ACL incompetence. In this cadaveric study, we digitally quantified the percentage of the lateral tibial plateau visualized under different conditions after performing an anterolateral surgical approach with submeniscal arthrotomy. Four conditions were assessed for articular visualization: (1) 30 degrees of knee flexion, (2) 110 degrees of knee flexion, (3) 110-degrees of knee flexion plus varus anterolateral rotatory vector, (4) 110-degrees of knee flexion plus varus anterolateral rotatory vector with ACL sacrifice (ACL incompetence model). In the ACL competent models, maximal lateral tibial plateau exposure was obtained with the knee positioned at 110 degrees of flexion with a varus anterolateral rotatory vector (58.2%, range: 52.9–63.4%). Articular visualization was further improved with the ACL incompetent model (82.4%, range: 77.1–87.7%), modeling a tibial eminence fracture.

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VIS-IT: Visualizing the Injured Tibia—A Cadaveric Study of Limb Positioning for Posterolateral Tibial Plateau Fracture Visualization

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“…They emphasized factors which contribute to the successful treatment for TPF included the updated philosophy taking in-jury mechanism, articular surface involvement and soft tissue injury into consideration allowed for individualized fixation strategies to be well planned for each case. Recently, Meulenkamp et al [ 5 ]. demonstrated that articular malreductions are common after tibial plateau fracture fixation, reaching more than 30%.…”

Section: Discussionmentioning

confidence: 99%

“…Row et al proposed [ 4 ] a staged method to treat high energy multicolumnar tibial plateau fractures. Meulenkamp et al [ 5 ] used cross-sectional imaging to examine the rate of articular malreduction. They found the rate was as high as 32.3%.…”

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confidence: 99%

A combined prone and supine approaches for complex three column tibial plateau fracture with posterolateral articular injury

Tarng

Lin

2019

Injury

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a b s t r a c tIntroduction: Updated three column fixation of tibial plateau fractures (TPFs) arouse the importance of posterior column articular reduction. Complex TPFs with posterolateral (PL) articular injury is difficult to manage. We presented a strategy of combined positions and approaches to treat these injuries. Surgical technique was described and outcome of these were reported. Materials and Methods: From 2014 Jan to 2016 Dec, there were 132 patients of TPFs treated in our institute. Preoperative evaluation included plain films and 2D/3D CT scan to evaluate the involvement of articular surface and associated columns. Inclusion criteria were three column TPFs with PL corner injury. We put patients in prone position first with reverse L incision to manage PL articular impaction and posteromedial (PM) fractures. Then we repositioned the patients in supine to treat anterolateral fixation. Postoperative radiographic analysis, physical examination findings, and patient reported outcome scores from the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire were recorded. Results: Patient demographic information was retrospectively reviewed with a mean follow-up time of 34.4 months (range 24-48 months). The average time to union was 5.2 months (range 4-8months). 13/16 (81%) of patients had satisfactory articular reduction by plain films (less than 2 mm articular step off). All patients demonstrated healed without secondary displacement or infection. All patients demonstrated satisfactory coronal (medial proximal tibia angle 84.68 degrees) and sagittal alignment (posterior proximal tibia angle 84.75 degrees). Condylar width averaged 3.93 mm. 3/16 (19%) of cases required posterolateral columnar plating in addition to posteromedial columnar plating. The knee range of motion averaged 115 degrees (ranged from 0 degrees of extension to140 degrees flexion). The average KOOS score was 83/100 (range 76-90). 3 patients in the series developed a surgical site superficial infection and resolved after debridement and oral antibiotics use. No patient eventually received total knee arthroplasty at the last follow up. Conclusions: Our strategy provides an effective method to treat three column tibial plateau fractures with PL articular injury.

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“…1,2 In particular, central articular fragments are often severely depressed, comminuted and hardly visible, and often leading to nonanatomical joint surface reconstructions. 3,4 Postoperative malreduction can cause clinically relevant deviation of the limb's mechanical axis and concomitant pseudoinstability. [3][4][5] In bicondylar tibial plateau fractures, osteoarthritis (OA) rates of up to 44% have been reported, especially in cases with severe articular comminution.…”

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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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Incidence, Risk Factors, and Location of Articular Malreductions of the Tibial Plateau

Abstract: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Cited by 71 publications

References 25 publications

VIS-IT: Visualizing the Injured Tibia—A Cadaveric Study of Limb Positioning for Posterolateral Tibial Plateau Fracture Visualization

VIS-IT: Visualizing the Injured Tibia—A Cadaveric Study of Limb Positioning for Posterolateral Tibial Plateau Fracture Visualization

A combined prone and supine approaches for complex three column tibial plateau fracture with posterolateral articular injury

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

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