Abstract
Posterolateral tibial plateau (PLTP) fractures are often associated with anterior
cruciate ligament (ACL) incompetence, such as tibial eminence fractures. Both occur
from a pivot shift like mechanism. Malreductions of the tibial plateau most frequently
occur in the posterolateral quadrant. Acquiring adequate intraoperative visualization
of the PLTP poses a challenge. We hypothesized that visualization of PLTP could be
improved by positioning the knee at 110 degrees of flexion with the addition of a
varus anterolateral rotatory vector. This position and maneuver take advantage of
both the nonisometric nature of the lateral soft tissues and, when present, ACL incompetence.
In this cadaveric study, we digitally quantified the percentage of the lateral tibial
plateau visualized under different conditions after performing an anterolateral surgical
approach with submeniscal arthrotomy. Four conditions were assessed for articular
visualization: (1) 30 degrees of knee flexion, (2) 110 degrees of knee flexion, (3)
110-degrees of knee flexion plus varus anterolateral rotatory vector, (4) 110-degrees
of knee flexion plus varus anterolateral rotatory vector with ACL sacrifice (ACL incompetence
model). In the ACL competent models, maximal lateral tibial plateau exposure was obtained
with the knee positioned at 110 degrees of flexion with a varus anterolateral rotatory
vector (58.2%, range: 52.9–63.4%). Articular visualization was further improved with
the ACL incompetent model (82.4%, range: 77.1–87.7%), modeling a tibial eminence fracture.
Keywords
tibial plateau fracture - surgical approach - posterolateral - cadaver
