Abstract
Purpose: The purpose of this study was to present the results of arthroscopy-assisted corrective osteotomy (AACO), reduction, internal fixation, and strut allograft augmentation for tibial plateau malunion or nonunion. Methods: Fifty-eight patients, mean age 49 ± 11.9 years old, with tibial plateau malunion (n = 44) or nonunion (n = 14), were included in this study. There were 19 Schatzker type II fractures (32.7%), 2 type III fractures (3.4%), 7 type IV fractures (12%), 20 type V fractures (34.5%), and 10 type VI fractures (17.2%). The mean follow-up period was 46.2 ± 17.6 months. Clinical and radiologic outcomes were scored by the Rasmussen system. Articular depression was measured from computed tomography. Secondary osteoarthritis was diagnosed when radiographs showed a narrowed joint space in the injured knee at follow-up. Results: Mean clinical score improved from 15.4 ± 3.9 (pre-revision) to 23.2 ± 4.5 (post-revision). Mean radiologic score improved from 7.7 ± 2.5 (pre-revision) to 12.0 ± 3.9 (post-revision). Fifty-six fractures achieved successful union. The average union time was 19.6 ± 7.5 weeks. Post-revision, 81% had good or excellent clinical results and 62% had good or excellent radiological results. Secondary osteoarthritis (OA) was noted in 91% of all injured knees, where 25.8% were mild OA, 25.8 % were moderate OA, and 38% were severe OA. There were 6 cases of deep infection (10.3%) and 1 case of wound edge necrosis (1.7%). Five cases were converted to total knee replacement after the index surgery with an average period of 13.5 months (range 8–24 months). Conclusions: Arthroscopy-assisted corrective osteotomy, reduction, internal fixation, and strut allograft augmentation can restore tibial plateau malunion/nonunion with well-documented radiographic healing and good clinical outcomes.
Highlights
Management of tibial plateau fractures is challenging
Open corrective osteotomy with bone grafting is the standard of care following malunion [2,4,5,6,7,8,9]
The purpose of this study was to present the radiological and clinical results of tibial plateau malunion or nonunion treated with arthroscopically-assisted corrective osteotomy (AACO) surgery
Summary
Management of tibial plateau fractures is challenging. Malreduction, improper fixation, neglected intra-articular lesions, and inadequate management of bone defects lead to the failure of surgical treatment [1,2,3,4,5]. The advantage of arthroscopically-assisted osteosynthesis of fractures of the tibial plateau are direct visualization of intra-articular fractures, accurate fracture reduction, reduced morbidity in comparison with arthrotomy, simplified diagnosis and treatment of meniscal and ligamentous injuries, thorough-joint lavage, and removal of loose fragments [10,11,12,13,14,15,16]. The purpose of this study was to present the radiological and clinical results of tibial plateau malunion or nonunion treated with arthroscopically-assisted corrective osteotomy (AACO) surgery. To our knowledge, this unique and novel method is not reported in the literature. We hypothesized that AACO surgery for tibial plateau malunion or nonunion wound allow accurate, stable alignment and articular surface reduction with minimal dissection and a satisfactory outcome
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