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J Knee Surg 2020; 33(02): 132-137
DOI: 10.1055/s-0038-1676799
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

VIS-IT: Visualizing the Injured Tibia—A Cadaveric Study of Limb Positioning for Posterolateral Tibial Plateau Fracture Visualization

Joseph K. Kendal 
1   Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada
,
Damian Clark
1   Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada
2   Department of Orthopaedics, Southmead Hospital, Bristol, United Kingdom
,
David Longino
1   Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada
,
Travis E. Marion
1   Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada
3   Division of Orthopaedic Surgery, Clinical Affiliate with the Northern Ontario School of Medicine, Sudbury, Ontario, Canada
,
Richard Buckley
1   Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada
,
Prism S. Schneider
1   Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada
,
Ryan Martin
1   Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada
› Author Affiliations Funding Funding was obtained through a Calgary Orthopaedic Research and Education Fund (COREF) grant, which had no role in the design, collection, analysis, or interpretation of data, or the decision to submit for publication.
Further Information

Publication History

01 May 2018

11 November 2018

Publication Date:
24 January 2019 (online)

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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

Authors' Contributions

All the authors were involved in study conception, design and data interpretation. J.K.K., D.C., D.L., and R.M. performed the cadaver dissections, application of external-fixator and tattooing of the cartilage. J.K.K. and D.C. performed digital quantifications of articular surface visualized. J.K.K. drafted the manuscript and all authors participated in critical review, as well as final manuscript approval.


 

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