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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

12-01-2023 | Meniscal Injury | KNEE

Posterior tibial plateau impaction fractures are not associated with increased knee instability: a quantitative pivot shift analysis

Authors: Brian M. Godshaw, Jonathan D. Hughes, Gian Andrea Lucidi, Joshua Setliff, Mikael Sansone, Jon Karlsson, Volker Musahl

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2023

Abstract

Purpose

This study aimed to evaluate posterolateral tibial plateau impaction fractures and how they contribute to rotatory knee laxity using quantitative pivot shift analysis. It was hypothesised that neither the presence of nor the degree of involvement of the plateau would affect rotatory knee laxity in the ACL-deficient knee.

Methods

A retrospective review of prospectively collected data on 284 patients with complete anterior cruciate ligament (ACL) injuries was conducted. Posterolateral tibial plateau impaction fractures were identified on preoperative MRI. The patients were divided into two cohorts: “fractures” or “no fractures”. The cohort with fractures was further categorised based on fracture morphology: “extra-articular”, “articular-impaction”, or “displaced-articular fragment”. All data were collected during examination under anaesthesia performed immediately prior to ACL reconstruction. This included a standard pivot shift test graded by the examiner and quantitative data including anterior tibial translation (mm) via Rolimeter, quantitative pivot shift (QPS) examination (mm) via PIVOT tablet technology, and acceleration (m/sec²) during the pivot shift test via accelerometer. Quantitative examinations were compared with the contralateral knee.

Results

There were 112 patients with posterolateral tibial plateau impaction fractures (112/284, 39%). Of these, 71/112 (63%) were “extra-articular”, 28/112 (25%) “articular-impaction”, and 13/112 (12%) “displaced-articular”. Regarding the two groups with or without fractures, there was no difference in subjective pivot shift (2 ± 0 vs 2 ± 0, respectively, n.s.), QPS (2.4 ± 1.6 mm vs 2.7 ± 2.2 mm, respectively, n.s.), anterior tibial translation measurements (6 ± 3 mm vs 5 ± 3 mm, respectively, n.s.), or acceleration of the knee during the pivot (1.7 ± 2.3 m/s² vs 1.8 ± 3.1 m/s², respectively, n.s.). When the fractures were further subdivided, subgroup analysis revealed no significant differences noted in any of the measured examinations between the fracture subtypes.

Conclusion

This study showed that the posterolateral tibial plateau impaction fractures are commonly encountered in the setting of ACL tears; however, contrary to previous reports, they do not significantly increase rotatory knee laxity. This suggests that this type of concomitant injury may not need to be addressed at the time of ACL reconstruction.

Level of evidence

Level III.

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Title: Posterior tibial plateau impaction fractures are not associated with increased knee instability: a quantitative pivot shift analysis
Authors: Brian M. Godshaw
Jonathan D. Hughes
Gian Andrea Lucidi
Joshua Setliff
Mikael Sansone
Jon Karlsson
Volker Musahl
Publication date: 12-01-2023
Publisher: Springer Berlin Heidelberg
Keywords: Meniscal Injury
Tibial Plateau Fracture
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07312-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Posterior tibial plateau impaction fractures are not associated with increased knee instability: a quantitative pivot shift analysis

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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