THE USE OF AN ANTERIOR INCISION OF THE MENISCUS FOR EXPOSURE OF TIBIAL PLATEAU FRACTURES REQUIRING OPEN REDUCTION AND INTERNAL-FIXATION

The purpose of this study was to examine the use of an anterior incisi on of the meniscus for exposure of tibial plateau fractures. We studie d 27 fractures of the proximal tibia treated with open reduction and i nternal fixation (ORIF). There were nine unicondylar fractures (five A -O B2; four A-O B3) fixed with plates and screws and 18 bicondylar fra ctures (seven A-O C1; five A-O C2; six A-O C3) fixed with combination internal and external fixation. Length of follow-up averaged 26 months . All patients were treated with an anterior incision of the meniscus and retraction with the condyle. Of the 18 bicondylar fractures, nine severely displaced fractures were found to have peripherally detached menisci. Unicondylar fractures did not display this finding. After fix ation, menisci were repaired at the periphery and sewn to the original anterior insertion. The repair begins posteriorly and advances the ca rtilage to ensure anatomic placement. There were four medial and 23 la teral menisci in this series. Ten patients underwent knee arthroscopy 6 months to 2 years post-ORIF as a routine procedure during hardware r emoval. All menisci were found to be healed to the periphery and were stable. There were no gross tears. In one patient, the anterior menisc al incision could be visualized. No patients developed mechanical symp toms either in postoperative rehabilitation or postoperative follow-up at a maximum of 6 years. All patients had >125 degrees of motion. Les s motion when compared with the normal knee was felt to be related to more complex fracture patterns. In conclusion, the anterior meniscal i ncision allows for excellent exposure of severe proximal tibia fractur es. This technique allows for anatomic meniscal repair and early rehab ilitation. Arthroscopic examination confirms peripheral meniscal heali ng. No patient experienced clinical symptoms of meniscal pathology.