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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2024 | Tibial Plateau Fracture | Research article

Effectiveness of bone grafting versus cannulated screw fixation in the treatment of posterolateral tibial plateau compression fractures with concomitant ACL injury: a comparative study

Authors: Yang Yang, Xiaofang Lin, Jianmin Zhang, Hanlong Xin, Dawei Han, Qingguo Zhang, Xiaobo Zhou

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

Abstract

Background

Posterolateral tibial plateau compression fractures (PTPCF) are one of the significant factors leading to knee instability and anterior cruciate ligament (ACL) reconstruction failure. The effectiveness of fixation for such cases without the use of metal implants remains inconclusive. The aim of this study is to investigate whether the fixation with isolated bone grafting is stable enough for the treatment of PTPCF with concomitant ACL injuries.

Methods

This retrospective study analyzed patients treated for concomitant ACL injuries and PTPCF in authors’ institution. A total of 53 patients (21 males and 32 females) with an average age of 47.43 ± 14.71 years were included. Patient data were collected, including factors leading to injury, affected side, height, weight, and basic medical history. The posterior inclination angle and the lateral tibial plateau lateral inclination angle were measured to evaluate the fixation stability. Rasmussen functional score and HSS score were used to assess the knee functional recovery.

Results

The bone grafting group achieved satisfactory levels of Rasmussen score (28.22 ± 0.85) and HSS knee joint function scores (95.57 ± 1.97). The cannulated screw fixation group had a Rasmussen knee joint function score of 28.70 ± 0.92 and a HSS knee joint function score of 96.07 ± 1.93. No statistically significant difference was found (P > 0.05). The cannulated screw fixation group had a mean posterior inclination angle reduction loss of 0.20° ± 1.11°, while the bone grafting group had a reduction loss of 0.18° ± 1.01°, with no statistically significant difference (P > 0.05). The cannulated screw fixation group had a lateral inclination angle reduction loss of 0.01° ± 0.37°, and the bone grafting group had a reduction loss of 0.03° ± 0.43°, with no statistically significant difference (P > 0.05).

Conclusion

The use of bone grafting for fixation of PTPCF with accompanying ACL injuries demonstrated no substantial disparities in knee joint function. In cases of simple PTPCF, filling and compacting the bone defect underneath the tibial plateau fracture fragment can yield satisfactory fixation, obviating the necessity for supplementary cannulate screw fixation.

Cho JW, Kim J, Cho WT, et al. Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures: a review with an emphasis on rim plating via modified anterolateral approach. Int Orthopaed. 2017;41(9):1887–97.CrossRef

Bernholt DL, Dephillipo NN, Crawford MD, et al. Incidence of displaced posterolateral tibial plateau and lateral femoral condyle impaction fractures in the setting of primary anterior cruciate ligament tear. Am J Sports Med. 2020;48(3):545–53. https://doi.org/10.1177/0363546519895239.CrossRefPubMed

Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update EFFORT. Open Rev. 2016;1(5):225–32. https://doi.org/10.1302/2058-5241.1.000031.CrossRef

Gardner MJ, Yacoubian S, Geller D, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthopaed Trauma. 2005;19(2):79–84. https://doi.org/10.1097/00005131-200502000-00002.CrossRef

Bargagliotti M, Benazzo F, Bellemans J, et al. The role of the posterolateral tibial slope in the rotational instability of the knee in patients affected by a complete isolated anterior cruciate ligament injury: its value in the decision-making process during the anterolateral ligament reconstruction. Joints. 2019;7(3):78–83. https://doi.org/10.1055/s-0040-1710386.CrossRefPubMed

Rahnemai-Azar AA, Abebe ES, Johnson P, et al. Increased lateral tibial slope predicts high-grade rotatory knee laxity pre-operatively in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017;25(4):1170–6. https://doi.org/10.1007/s00167-016-4157-3.CrossRefPubMed

Bongbong DN, Oeding JF, Ma CB, et al. Posterior tibial slope, notch width, condylar morphology, trochlear inclination, and tibiofemoral mismatch predict outcomes following anterior cruciate ligament reconstruction. Arthroscopy. 2022;38(5):1689-1704.e1681. https://doi.org/10.1016/j.arthro.2021.11.055.CrossRefPubMed

Bernholt DL, Dornan GJ, Dephillipo NN, et al. High-grade posterolateral tibial plateau impaction fractures in the setting of a primary anterior cruciate ligament tear are correlated with an increased preoperative pivot shift and inferior postoperative outcomes after anterior cruciate ligament reconstruction. Am J Sports Med. 2020;48(9):2185–94. https://doi.org/10.1177/0363546520932912.CrossRefPubMed

Flury A, Hodel S, Andronic O, et al. Extent of posterolateral tibial plateau impaction fracture correlates with anterolateral complex injury and has an impact on functional outcome after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2023;31(6):2266–73. https://doi.org/10.1007/s00167-022-07282-y.CrossRefPubMed

10.

Yang Y, Zhou X, Ji H, et al. A novel arthroscopically assisted reduction technique for three patterns of posterolateral tibial plateau fractures. J Orthopaed Surg Res. 2020;15(1):376. https://doi.org/10.1186/s13018-020-01901-5.CrossRef

11.

Park JP, Laverdière C, Corban J, et al. An arthroscopic procedure for restoration of posterolateral tibial plateau slope in tibial plateau fracture associated with anterior cruciate ligament injuries. Arthrosc Tech. 2020;9(9):e1249–58. https://doi.org/10.1016/j.eats.2020.05.003.CrossRefPubMedPubMedCentral

12.

Lubowitz JH, Vance, M Ayala, et al. 2006 Interference screw technique for arthroscopic reduction and internal fixation of compression fractures of the tibial plateau. Arthroscopy. 22(12):1359.e1351–53. https://doi.org/10.1016/j.arthro.2006.04.110

13.

Li L, Li Y, He Y, et al. Single-stage arthroscopic-assisted treatment of anteromedial tibial plateau fracture with posterolateral corner injury: a retrospective study. BMC Musculoskelet Disord. 2022;23(1):420. https://doi.org/10.1186/s12891-022-05387-6.CrossRefPubMedPubMedCentral

14.

Korthaus A, Warncke M, Pagenstert G, et al. Lateral femoral notch sign and posterolateral tibial plateau fractures and their associated injuries in the setting of an anterior cruciate ligament rupture. Arch Orthopaed Trauma Surg. 2022;142(7):1605–12. https://doi.org/10.1007/s00402-021-04105-6.CrossRef

15.

Filardo G, Andriolo L, Di Laura Frattura G, et al. Bone bruise in anterior cruciate ligament rupture entails a more severe joint damage affecting joint degenerative progression. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):44–59. https://doi.org/10.1007/s00167-018-4993-4.CrossRefPubMed

16.

Krause M, Menzdorf L, Preiss A, et al. Are there four tibial plateau columns? Yes there are, as illustrated by a postero-lateral apple-bite fracture. Response to a letter-to-the-editor. Int Orthopaed. 2018;42(2):443–6. https://doi.org/10.1007/s00264-017-3686-9.CrossRef

17.

Menzdorf L, Drenck T, Akoto R, et al. Clinical results after surgical treatment of posterolateral tibial plateau fractures (“apple bite fracture”) in combination with ACL injuries. Eur J Trauma Emerg Surg. 2020;46(6):1239–48. https://doi.org/10.1007/s00068-020-01509-8.CrossRefPubMed

18.

Bernholt DL, Dephillipo NN, Grantham WJ, et al. Morphologic variants of posterolateral tibial plateau impaction fractures in the setting of primary anterior cruciate ligament tear. Am J Sports Med. 2020;48(2):318–25. https://doi.org/10.1177/0363546519893709.CrossRefPubMed

19.

Xie X, Zhan Y, Wang Y, et al. Comparative analysis of mechanism-associated 3-dimensional tibial plateau fracture patterns. J Bone Joint Surg Am. 2020;102(5):410–8. https://doi.org/10.2106/jbjs.19.00485.CrossRefPubMed

20.

Lian J, Novaretti JV, Sheean AJ, et al. Static lateral tibial plateau subluxation predicts high-grade rotatory knee laxity in anterior cruciate ligament-deficient knees. Am J Sports Med. 2019;47(2):277–84. https://doi.org/10.1177/0363546518812435.CrossRefPubMed

21.

Ni QK, Song GY, Zhang ZJ, et al. Steep posterior tibial slope and excessive anterior tibial translation are predictive risk factors of primary anterior cruciate ligament reconstruction failure: a case-control study with prospectively collected data. Am J Sports Med. 2020;48(12):2954–61. https://doi.org/10.1177/0363546520949212.CrossRefPubMed

22.

Ackermann C, Frings J, Alm L, et al. Arthroscopic controlled closed reduction and percutaneous fixation of posterolateral tibia plateau impression fractures. Arthrosc Tech. 2019;8(8):e867–74. https://doi.org/10.1016/j.eats.2019.04.001.CrossRefPubMedPubMedCentral

23.

Holzach P, Matter P, Minter J. Arthroscopically assisted treatment of lateral tibial plateau fractures in skiers: use of a cannulated reduction system. J Orthopaed Trauma. 1994;8(4):273–81. https://doi.org/10.1097/00005131-199408000-00001.CrossRef

24.

Zhang W, Luo CF, Putnis S, et al. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. The Knee. 2012;19(2):94–8. https://doi.org/10.1016/j.knee.2011.02.004.CrossRefPubMed

25.

Sun H, He QF, Zhang BB, et al. A biomechanical evaluation of different fixation strategies for posterolateral fragments in tibial plateau fractures and introduction of the “magic screw.” The Knee. 2018;25(3):417–26. https://doi.org/10.1016/j.knee.2018.03.015.CrossRefPubMed

26.

Smith PN, Refshauge KM, Scarvell JM. Development of the concepts of knee kinematics. Arch Phys Med Rehabil. 2003;84(12):1895–902. https://doi.org/10.1016/s0003-9993(03)00281-8.CrossRefPubMed

27.

Freeman MA, Pinskerova V. The movement of the normal tibio-femoral joint. J Biomech. 2005;38(2):197–208. https://doi.org/10.1016/j.jbiomech.2004.02.006.CrossRefPubMed

28.

Gharedaghi M, Peivandi MT, Mazloomi M, et al. Evaluation of clinical results and complications of structural allograft reconstruction after bone tumor surgery. Arch Bone Joint Surg. 2016;4(3):236–42.PubMedPubMedCentral

Title: Effectiveness of bone grafting versus cannulated screw fixation in the treatment of posterolateral tibial plateau compression fractures with concomitant ACL injury: a comparative study
Authors: Yang Yang
Xiaofang Lin
Jianmin Zhang
Hanlong Xin
Dawei Han
Qingguo Zhang
Xiaobo Zhou
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: Tibial Plateau Fracture
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-023-04516-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effectiveness of bone grafting versus cannulated screw fixation in the treatment of posterolateral tibial plateau compression fractures with concomitant ACL injury: a comparative study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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