Arthroscopic treatment of tibial plateau fractures. Report on 26 cases

Purpose of the study Arthroscopic treatment of tibial plateau fractures may reduce morbidity com pared to open articular surgery. But bony fixation is necessarily percutane ous and minimal. The purpose of our study was not only to assess immediate results but also long term functional and anatomic results after arthroscop ic treatment of tibial plateau fractures, with special reference to radiogr aphical results. Material and methods Twenty-six patients (mean age 42 years, range 18 to 70 years, 17 men, 9 wom en) were arthroscopically treated for a fresh tibial plateau fracture. Acco rding to Schatzker classification, there was 2 type I, 17 type II, 6 type I II and 1 type IV. No type V or VI were treated in this series. The fixation device was: percutaneous cannulated screw in 23 cases, Kirchner wire in 2 cases, and bone cement filing of the fracture site in 1 case. We did not us e cancellous bone graft but we used a hydroxyapatite plug in one case. Ther e were 8 meniscal injuries: 2 underwent arthroscopic suture, I had partial meniscectomy and 5 were left in place. Twenty-six cases were suitable for immediate post op follow up. 19 were rev iewed at long term. A clinical (Knee Society scoring system) and radiograph ical examination were done with an average follow-up of 32.7 months. Results There were no complications except one immediate postoperative septic osteo arthritis (case with hydroxyapatite plug) and one bony depression of the la teral tibial plateau at the fourth month. Passive motion of the knee starte d at 1.8 days postop with no pain. Mean flexion at 3 months was 130 degrees . At revision, the average score was: 94.1 for the knee, 94.7 for the functio n. In two cases we found early signs of osteoarthrosis. There were no secon dary bony depression or significant valgus deformity on X-rays. Conclusion Arthroscopic management of tibial plateau fractures allows a complete artic ular screening. Rapid rehabilitation, short hospital stay, and low rate of complications reduce morbidity. The long term results are as good as those with open surgical technique for the types of fracture that we have treated (type III and IV). A minimal, percutaneous osteosynthesis which was the on ly possibility under arthroscopic control, did not modify the anatomical re sults.