Main Article Content
tibial plateau fractures, arthroscopy, internal fixation, joint trauma, post-traumatic osteoarthritis
Background and Aim of the work: Tibial plateau fractures include a wide spectrum of lesions with
potentially disabling sequelae. Arthroscopically-assisted Reduction and Internal Fixation (ARIF) is an alternative
to traditional ORIF. The aim of this retrospective single centre study is to evaluate medium-term clinical and
radiographic outcomes achieved in a consecutive series of patients treated with ARIF. Methods: 21 patients, with a mean age of 52.2 ± 13.4 years at surgery, were included. According to Schatzker classification, there were 9 type II, 10 type III, 2 type IV fractures. Associated intra-articular injuries (meniscal tears, tibial spine fractures, chondral lesions) were detected in 8 patients. At follow up, patients were clinically and radiographically evaluated according to knee ROM, KOOS, OKS and Rasmussen Clinical and Radiological Scores. Results: At an average follow-up of 84 ± 22.5 months, 18 patients were evaluated. Mean values recorded were the following: knee ROM 1° - 135°, OKS 41.6 / 48 ± 8.18, subscale KOOS scores ranged from 75% ± 25.4 (Quality of Life) to 91.1% ± 11.2 (Pain), Rasmussen Clinical e Radiological 27.2 ± 2.64 (14 excellent, 3 good, 1 fair) and 9.1 ± 0.64 (15 excellent, 3 good) respectively. Worse results were observed in 5 patients with pre-existing degenerative chondropathy. Conclusions: ARIF revealed to be an effective technique for surgical treatment of unicondylar tibial plateau fractures. Our findings support the favourable results reported by other authors. ARIF is not a simple technique and requiresspecific experience in knee arthroscopy and a steep learning curve.(www.actabiomedica.it)
2. He Q fang, Sun H, Shu L yuan, Zhan Y, He C yan, Zhu Y, et al. Tibial plateau fractures in elderly people: an institutional retrospective study. J Orthop Surg Res 2018; 13:1–8.
3. Frattini M, Vaienti E, Soncini G, Pogliacomi F. Tibial plateau fractures in elderly patients. Chir Organi Mov 2009; 93:109–14.
4. Van Dreumel RLM, Van Wunnik BPW, Janssen L, Simons PCG, Janzing HMJ. Mid- to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures. Injury 2015; 46:1608–12.
5. Elsoe, R., Larsen, P., Nielsen N et al., Elsoe R, Larsen P, Nielsen NPH, Swenne J, Rasmussen S, et al. Population-Based Epidemiology of Tibial Plateau Fractures. Orthopedics 2015; 38:e780–e786.
6. Cassard X, Beaufils P, Blin JL, Hardy P. Arthroscopic treatment of tibial plateau fractures. Report on 26 cases. Rev Chir Orthop Reparatrice Appar Mot 1999; 85:257–66.
7. Guanche CA, Markman AW. Arthroscopic management of tibial plateau fractures. Arthroscopy. 1993; 9:467–71.
8. Siegler J, Galissier B, Marcheix PS, Charissoux JL, Mabit C, Arnaud JP. Percutaneous fixation of tibial plateau fractures under arthroscopy: A medium term perspective. Orthop Traumatol Surg Res 2011; 97:44–50.
9. Stahl D, Serrano-Riera R, Collin K, Griffing R, Defenbaugh B, Sagi HC, et al. Operatively treated meniscal tears associated with tibial plateau fractures: A report on 661 patients. J Orthop Trauma 2015; 29:322–4.
10. Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev. 2016; 1:225–32.
11. Caspari RB, Hutton PM, Whipple TL, Meyers JF. The role of arthroscopy in the management of tibial plateau fractures. Arthroscopy 1985; 1:76–82.
12. Jennings J. Arthroscopic management of tibial plateau fractures. Arthroscopy 1985; 1:160–8.
13. Duan XJ, Yang L, Guo L, Chen GX, Dai G. Arthroscopically assisted treatment for Schatzker type I-V tibial plateau fractures. Chinese J Traumatol (Eng.) 2008; 11:288–92.
14. Pogliacomi F, Verdano MA, Frattini M, Costantino C, Vaienti E, Soncini G. Combined arthroscopic and radioscopic management of tibial plateau fractures: Report of 18 clinical cases. Acta Biomed 2005; 76:107–14.
15. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res 1979; 138:94–104.
16. Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am 1973; 55-A:1331-50.
17. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS) - Development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998; 28:88-96.
18. Monticone M, Ferrante S, Salvaderi S, et al. Development of the Italian version of the knee injury and osteoarthritis outcome score for patients with knee injuries: Cross-cultural adaptation, dimensionality, reliability, and validity. Osteoarthr Cartil 2012; 20:330–5.
19. Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 1998; 80-B:63–9.
20. Padua R, Zanoli G, Ceccarelli E, Romanini E, Bondì R, Campi A. The Italian version of the Oxford 12-item knee questionnaire - Cross-cultural adaptation and validation. Int Orthop. 2003; 27:214–6.
21. Rossi R, Bonasia DE, Blonna D, Assom M, Castoldi F. Prospective follow-up of a simple arthroscopic-assisted technique for lateral tibial plateau fractures: Results at 5 years. Knee 2008; 15:378–83.
22. Dall’Oca C, Maluta T, Lavini F, Bondi M, Micheloni GM, Bartolozzi P. Tibial plateau fractures: Compared outcomes between ARIF and ORIF. Strateg Trauma Limb Reconstr. 2012; 7:163–75.
23. Burdin G. Arthroscopic management of tibial plateau fractures: surgical technique. Orthop Traumatol Surg Res 2013; 99(1 Suppl):S208-18.
24. Abdel-Hamid MZ, Chang CH, Chan YS, Lo YP, Huang JW, Hsu KY, et al. Arthroscopic Evaluation of Soft Tissue Injuries in Tibial Plateau Fractures: Retrospective Analysis of 98 Cases. Arthroscopy 2006; 22:669–75.
25. Chen XZ, Liu CG, Chen Y, Wang LQ, Zhu QZ LP, Chen XZ, Liu CG, Chen Y, Wang LQ, Zhu QZ, et al. Arthroscopy-assisted surgery for tibial plateau fractures. Arthroscopy. 2015; 31:143–53.
26. Vaienti E., Scita G., Ceccarelli F., Pogliacomi F. Understanding the human knee and its relationship to total knee replacement. Acta Biomed. 2017 Jun 7; 88(2 -S): 6-16.
27. Gill TJ, Moezzi DM, Oates KM, Sterett WI. Arthroscopic reduction and internal fixation of tibial plateau fractures in skiing. Clin Orthop Relat Res. 2001; 383:243–9
28. Verona M, Marongiu G, Cardoni G, Piras N, Frigau L, Capone A. Arthroscopically assisted reduction and internal fixation (ARIF) versus open reduction and internal fixation (ORIF) for lateral tibial plateau fractures: A comparative retrospective study. J Orthop Surg Res. 2019; 14:155.