Efficacy and experience of arthroscopy-assisted reduction and internal fixation for posterior lateral tibial plateau fractures

HU Wen-yong; TANG Yu; LIN Hong-kai

doi:10.3969/j.issn.2095-252X.2024.10.010

Abstract：Objective To compare the difference in efficacy between arthroscopically-assisted reduction and internal fixation(ARIF)and open reduction and internal fixation(ORIF)in the treatment of posterior posterolateral tibial plateau fractures.Methods Patients with posterior lateral tibial plateau fracture who were treated with ARIF or ORIF in our hospital from January 2021 to June 2022 were selected and matched by propensity score according to age and gender in a 1:1 manner,and finally 47 patients were enrolled in both ARIF and ORIF group.Perioperative clinical data of the affected patients were collected.Hospital for special surgery knee score(HSS)was assessed for knee symptoms and functional assessment.Imaging parameters were assessed using the Rasmussen radiological score,and the tibial plateau width(TPW),articular depression depth(ADD),proximal medial tibial angulation(MPTA)and proximal tibial angulation(PTSA)were measured and compared.Results The operative time[(143.52±14.65)min vs.(79.21±15.14)min]and intraoperative exposure[(6.41±2.02)vs.(4.15±1.78)]were higher in the ARIF group than that in the ORIF group(P<0.05);the intraoperative bleeding volume[(75.62±9.58)ml vs.(175.26±10.05)ml],incision length[(7.98±2.22)cm vs.(12.05±2.65)cm],postoperative drainage[(62.74±4.74)ml vs.(76.74±4.89)ml]and postoperative hospital stay[(1.54±1.05)weeks vs.(2.41±1.14)weeks]were lower than that in the ORIF group(P<0.05).At 12 months after surgery,the HSS score[(185.49±3.14)vs.(71.91±4.14)]was higher in the ARIF group than in the ORIF group(P<0.05);the ROM of the affected knee joint[(128.89±7.36)° vs.(125.76±7.55)°]was higher in the ARIF group than in the ORIF group(P<0.05),and the difference in ROM of the affected knee joint was lower than that of the contralateral knee joint.Knee ROM difference was smaller[(-3.48±0.97)° vs.(-7.36±1.01)°](P<0.05).At 12 months postoperatively,the Rasmussen radiological score[(14.79±3.17)vs.(12.24±4.25)]was higher in the ARIF group than that in the ORIF group(P<0.05).ARIF group had lower ADD[(1.37±1.31)mm vs.(2.13±1.33)mm]at 6 months and at 12 months[(2.12±1.12)mm vs.(2.71±1.25)mm]postoperatively than that in the ORIF group(P<0.05).Conclusions Both ARIF and ORIF provide satisfactory results in treating patients with posterior posterolateral tibial plateau fractures,but ARIF has better reduction and functional recovery.ARIF is recommended for the routine treatment ofposterior lateral tibial plateau fractures.