Long-term outcome after surgical treatment of intra-articular tibial plateau fractures in skiers
- 84 Downloads
Tibial plateau fractures occur frequently during downhill skiing. There is a lack of information about the outcome and development of posttraumatic osteoarthritis after internal fixation of such fractures at long-term follow-up in skiers.
Materials and methods
A population of 83 skiers was followed up in a case series after internal fixation of intra-articular tibial plateau fractures AO-OTA 41 B1-B3 and C1-C3. Functional outcomes Visual Analog Scale, Tegner Activity Scale, Modified Lysholm Score, Hospital for Special Surgery (HSS) Knee Score and X-ray images of the affected knees (preoperative, postoperative and at time of follow-up) were obtained. Radiological evaluation focused on severity of osteoarthritis according to the Kellgren and Lawrence score of the lateral, medial and retropatellar knee compartments separately. Subgroup analyses for fracture type and age were performed separately.
Patients age was 49.8 ± 12.9 years (range 19–74 years) at the time of surgery, with a mean follow-up period of 10.3 ± 1.9 years (range 6–14 years). All tibial plateau fractures affected the lateral compartment, while the medial compartment was affected in addition as part of bicondylar fractures in two cases. Both the Tegener Activity Scale and Lysholm Score decreased significantly during the follow-up period and their median values dropped from 6 (range 3–7) to 5 (range 2–7) and from 100 (range 90–100) to 95 (range 58–100), respectively (both p < .01). The median clinical knee function at the time of follow-up revealed an HSS Knee Score of 96.5 points (range 74–100). Among the whole patient population, the radiological evaluation at follow-up revealed a significantly higher grade of osteoarthritis in all compartments of the knee joint compared to the time of the operation (p < .01). The grade of osteoarthritis in the lateral compartment was significantly higher than that in the medial and retropatellar compartments (p < .01).
In addition to physiologic aging, progression of radiologic signs of osteoarthritis following internal fixation of intra-articular tibial plateau fractures in an athletic population of skiers is most severe in the lateral knee compartment corresponding to fracture location. However, the long-term functional outcomes seem to be very satisfactory.
KeywordsTibia Fracture Skiers Osteoarthritis Outcome
The authors thank all their patients for the participation and the staff of the Davos Hospital for support of this study.
There is no funding source.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved by the institutional review board.
Informed consent was obtained from all individual participants included in the study in accordance with the declaration of Helsinki.
- 3.Orapiriyakul W, Apivatthakakul T, Phornphutkul C (2018) Posterolateral tibial plateau fractures, how to buttress? Reversed L posteromedial or the posterolateral approach: a comparative cadaveric study. Arch Orthop Trauma Surg 138(4):505–513. https://doi.org/10.1007/s00402-018-2875-3 CrossRefGoogle Scholar
- 6.Aktas E, Sener E, Gocun PU (2011) Mechanically induced experimental knee osteoarthritis benefits from anti-inflammatory and immunomodulatory properties of simvastatin via inhibition of matrix metalloproteinase-3. J Orthop Traumatol 12(3):145–151. https://doi.org/10.1007/s10195-011-0154-y CrossRefGoogle Scholar
- 7.Ebraheim NA, Sabry FF, Haman SP (2004) Open reduction and internal fixation of 117 tibial plateau fractures. Orthopedics 27(12):1281–1287Google Scholar
- 14.Marsh JL, Borrelli J, Dirschl DR, Sirkin MS (2007) Fractures of the tibial plafond. Instr Course Lect 56:331–352Google Scholar
- 18.Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248:13–14Google Scholar
- 19.Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49Google Scholar
- 25.Kraus TM (2012) Return to sports activity after tibial plateau fractures 89 cases with minimum 24-month follow-up. Am J Sports Med 40(12). https://doi.org/10.1177/0363546512462564
- 27.Canadian Orthopaedic Trauma Society (2006) Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg Am 88(12):2613–2623. https://doi.org/10.2106/JBJS.E.01416 CrossRefGoogle Scholar
- 33.Kalmet PHS, Van Horn YY, Sanduleanu S, Seelen HAM et al (2018) Patient-reported quality of life and pain after permissive weight bearing in surgically treated trauma patients with tibial plateau fractures: a retrospective cohort study. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-018-3088-5 Google Scholar
- 34.Gausden E, Garner MR, Fabricant PD, Warner SJ, Shaffer AD, Lorich DG (2017) Do clinical outcomes correlate with bone density after open reduction and internal fixation of tibial plateau fractures. Arch Orthop Trauma Surg 137(6):755–760. https://doi.org/10.1007/s00402-017-2679-x CrossRefGoogle Scholar