Arthroscopic Treatment of Knee Fractures

  • S.L. Mortimer
  • Robert Hunter

Tibial plateau fractures can be a challenging injury to manage for orthopaedic surgeons. Management of these fractures has evolved from immobilization, skeletal traction, open reduction, and internal fixation to (all) arthroscopic reduction and internal fixation for some fracture types. Although not all fractures are amenable to arthroscopic reduction and fixation techniques, the arthroscope is still an important instrument for intraarticular diagnostic and treatment purposes. Arthroscopy provides potential advantages over other methods of treatment, by allowing for complete and accurate diagnosis of intraarticular pathology, earlier and better recovery of joint motion, less soft tissue dissection, and anatomic restoration of the joint surface.


Anterior Cruciate Ligament Tibial Plateau Compartment Syndrome Anatomic Reduction Tibial Plateau Fracture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Kendall NS, Hsu SYC, Chan K. Fracture of the tibial spine in adults and children. J Bone Joint Surg Br 1992;74:848–852.PubMedGoogle Scholar
  2. 2.
    Meyers MH, McKeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1959;41:209–222.PubMedGoogle Scholar
  3. 3.
    Gronkvist H, Hirsch G, Johansson L. Fracture of the anterior tibial spine in children. J Pediatr Orthop 1984;4:465–468.PubMedCrossRefGoogle Scholar
  4. 4.
    Wiss DA, Watson JT. Fractures of the tibial plateau. In Rockwood CA, Green DP, Bucholz RW, Heckman JD (eds.), Rockwood and Green’s Fractures in Adults. Philadelphia: Lippincott-Raven, 1996, pp. 1920–1953.Google Scholar
  5. 5.
    Schatzker J. Tibial plateau fractures. In Browner BD, Jupiter JB, Levine AM, Trafton PG (eds.), Skeletal Trauma. Philadelphia: WB Saunders, 1992, pp. 1745–1770.Google Scholar
  6. 6.
    Chandler JT, Miller TM. Tibial eminence fracture with meniscal entrapment. Arthroscopy 1995;11:499–502.PubMedCrossRefGoogle Scholar
  7. 7.
    Owens BD, Crane GK, Plante T, Busconi BD. Treatment of type III tibial intercondylar eminence fractures in skeletally immature atrhletes. Am J Orthop 2003;33:103–105.Google Scholar
  8. 8.
    Wiley JJ, Baxter MP. Tibial spine fractures in children. Clin Orthop Relat Res 1990;255:54–60.PubMedGoogle Scholar
  9. 9.
    Meyers MH, McKeevor FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1970;52:1677–1683.PubMedGoogle Scholar
  10. 10.
    Noyes FR, DeLucas JL, Torvik PJ. Biomechanics of anterior cruciate ligament failure; an analysis of strain-rate sensitivity and mechanism of failure in primates. J Bone Joint Surg Am 1974;56:236–153.PubMedGoogle Scholar
  11. 11.
    Lubowitz JH, Elson WS, Guttman D. Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures. Arthroscopy 2005;21:86–92.PubMedCrossRefGoogle Scholar
  12. 12.
    Vangness Ct, Gharderi B, Hohl M, Moore TM. Arthroscopy of meniscal injuries with tibial plateau fractures. J Bone Joint Surg Br 1994;76:488–490.Google Scholar
  13. 13.
    McClellan RT, Comstock CP. Evaluation and treatment of tibial plateau fractures. Curr Opin Orthop 1999;10:10–21.CrossRefGoogle Scholar
  14. 14.
    Kode L, Lieberman JM, Motta AO, Wilber JH, Vasen A, Ya-gan R. Evaluation of tibial plateau fractures: efficacy of MR imaging compared with CT. AJR Am J Roentgenol 1994;63:141–147.Google Scholar
  15. 15.
    Yacoubian SV, Nevins RT, Sallis JG, Potter H, Lorich D. Impact of MRI on treatment plan and fracture classification of tibial plateau fractures. J Orthop Trauma 2002;16:632–637.PubMedCrossRefGoogle Scholar
  16. 16.
    Holt MD, Williams LA, Dent CM. MRI in the manament of tibial plateau fractures. Injury 1995;26:595–599.PubMedCrossRefGoogle Scholar
  17. 17.
    Brophy DP, O’Malley M, Lui D, Denison B, Eustace S. MR imaging of tibial plateau fractures. Clin Radiol 1996;51:873–878.PubMedCrossRefGoogle Scholar
  18. 18.
    Mui LW, Engelsohn E, Umans H. Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury? Skeletal Radiol 2007;36:245–251.Google Scholar
  19. 19.
    Zaricznyj B. Avulsion fracture of the tibial eminence treated by open reduction and pinning. J Bone Joint Surg Am 1997;59:1111–1114.Google Scholar
  20. 20.
    McLennan JG. The role of arthroscopic surgery in the treatment of fractures of the intercondylar eminence of the tibia. J Bone Joint Surg Br 1982;64:477–480.PubMedGoogle Scholar
  21. 21.
    Falstie-Jensen S, Sondergard Peterson PE. Incarceration of the meniscus in fractures of the intercondylar eminence of the tibia in children. Injury 1984;15:236–238.PubMedCrossRefGoogle Scholar
  22. 22.
    Brown TD, Anderson DD, Nepola JV, Singerman, RJ, Pedersen DR, Brandet RA. Contact stress aberrations following imprecise reduction of simple tibial plateau fractures. J Orthop Res 1988;6:851.PubMedCrossRefGoogle Scholar
  23. 23.
    Bai B, Kummer FJ, Sala DA, Koval JK, Wolinsky PR. Effect of articular step-off and meniscectomy on joint alignment and contact pressures of fractures of the lateral tibial plateau. J Orthop Trauma 2001;15:101–106.PubMedCrossRefGoogle Scholar
  24. 24.
    Walker S, Erkman MJ. The role of the menisci in force transmission across the knee. Clin Orhthop 1975;109:184.CrossRefGoogle Scholar
  25. 25.
    Kettlekamp DB, Hillberry BM, Murrish DE, Da H. Degenerative arthritis of the knee secondary to fracture malunion. Clin Orthop 1988;234:159.Google Scholar
  26. 26.
    Daniel D, Rice T. Valgus-varus stability in a hinged cast used for controlled mobilization of the knee. J Bone Joint Surg Am 1979;61:135.PubMedGoogle Scholar
  27. 27.
    DeCoster TA, Nepola JV. Cast brace treatment of proximal tibial plateau fractures: ten year follow-up study. Clin Orthop 1988;231:196.PubMedGoogle Scholar
  28. 28.
    Delamarter R, Hohl M. The cast brace and tibial plateau fractures. Clin Orthop 1989;242:26.PubMedGoogle Scholar
  29. 29.
    Cassard X, Beaufils P, Blin JL, Hardy P. Osteosynthesis under arthroscopic control of separated tibial plateau fractures. 26 case reports. Rev Chir Orthop Reparatice Appar Mot 1999;85:257–266.Google Scholar
  30. 30.
    Lemon RA, Bartlett DH. Arthroscopic assisted internal fixation of certain fractures about the knee. J Trauma 1985;25:355–358.PubMedCrossRefGoogle Scholar
  31. 31.
    Buchko GM, Johnson DH. Arthroscopically assisted operative management of tibial plateau fractures. Clin Orthop Relat Res 1996;332:29–36.PubMedCrossRefGoogle Scholar
  32. 32.
    Jennings JE. Arthroscopic management of tibial plateau fractures. Arthroscopy 1985;1:160–168.PubMedCrossRefGoogle Scholar
  33. 33.
    Gill TJ, Moezzi DM, Oates K, Sterett WI. Arthroscopic reduction and internal fixation of tibial plateau fractures in skiing. Clin Orthop Relat Res 2001;383:243–249.PubMedCrossRefGoogle Scholar
  34. 34.
    Lubowitz JH, Elson WS, Guttmann D. Part I: arthroscopic management of tibial plateau fractures. Arthroscopy 2004;20:1063–1070.PubMedCrossRefGoogle Scholar
  35. 35.
    Baxter MP, Wiley JJ. Fractures of the tibial spine in children. J Bone Joint Surg Br 1988;70:228–230.PubMedGoogle Scholar
  36. 36.
    Willis RB, Blokker C, Stoll TM, Paterson DC, Galpin RD. Long-term follow-up of anterior tibial eminence fractures. J Ped Orthop 1993;13:361–364.CrossRefGoogle Scholar
  37. 37.
    Lee Y, Chin L, Wang N, Hou CH, Lo WH. Anterior tibial spine fracture in children: follow-up evaluation by biomechanical studies. Chin Med J 1996;58:183–189.Google Scholar
  38. 38.
    Beaty JH, Kumar A. Fractures about the knee in children. J Bone Joint Surg Am 1994;76:1870–1880.PubMedGoogle Scholar
  39. 39.
    Fyfe IS, Jackson JP. Tibial intercondylar fractures in children: a review of the classification and the treatement of malunion. Injury 1981;13:165–169.PubMedCrossRefGoogle Scholar
  40. 40.
    Mah JY, Otsuka NY, Mclean J. An arthroscopic technique for the reduction and fixation of tibial-eminence fractures. J Ped Orthop 1996;16:119–121.CrossRefGoogle Scholar
  41. 41.
    Janarv P, Westblad P, Johansson C, Hirsch G. Long-term follow-up of anterior tibial spine fractures in children. J Ped Orthop 1995;15:63–68.CrossRefGoogle Scholar
  42. 42.
    Osti L, Merlo F, Bocchi L. Our experience in the arthroscopic treatment of fracture-avulsion of the tibial spine. Chir Organi Mov 1997;82:295–299.PubMedGoogle Scholar
  43. 43.
    Matthews DE, Geissler WB. Arthroscopic suture fixation of displaced tibial eminence fractures. Arthroscopy 1994;10:418–423.PubMedCrossRefGoogle Scholar
  44. 44.
    Hunter RE, Willis JA. Arthroscopic fixation of avulsion fractures of the tibial eminence: technique and outcome. Arthroscopy 2004;20:113–121.PubMedGoogle Scholar
  45. 45.
    Lubowitz JH, Grauer JD. Arthroscopic treatment of anterior cruciate ligament avulsion. Clin Orthop Relat Res 1993;294:242–246.PubMedGoogle Scholar
  46. 46.
    Biyani A, Reddy NS, Chaudhury J, Simison AJ, Klenerman L. The results of surgical management of displaced tibial plateau fractures in the elderly. Injury 1995;26:291.PubMedCrossRefGoogle Scholar
  47. 47.
    Honkonen SE, Kannus P, Natri A, Latvala K, Jarvinen MJ. Isokinetic performance of the thigh muscles after tibial plateau fractures. Int Orthop 1997;21:323.PubMedCrossRefGoogle Scholar
  48. 48.
    Benirschke SK, Agner SG, Mayo KA, et al. Open reduction internal fixation of complex proximal tibial fractures. J Orthop Trauma 1991;5:236.CrossRefGoogle Scholar
  49. 49.
    Smith JB. Knee instability after fractures of the intercondylar eminence of the tibia. J Ped Orthop 1984;4:462–464.CrossRefGoogle Scholar
  50. 50.
    Senekovic V, Veselko M. Anterograde arthroscopic fixation of avulsion fractures of the tibial eminence with a cannulated screw: five-year results. Arthroscopy 2003;19:54–61.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • S.L. Mortimer
    • 1
  • Robert Hunter
  1. 1.Department of Orthopaedic Surgery, Arizona Institute for Sports MedicineUniversity of ArizonaTucsonArizona

Personalised recommendations