Improved Visualization by Central Subluxation of the Lateral Meniscus in Comminuted Lateral Tibial Plateau Fractures

Abstract

The goal of surgical reconstruction of comminuted tibial plateau fractures is an anatomical reconstruction and stable fixation of the articular surface. This can be difficult due to poor visualization of the posterolateral and central segments of the articular surface of the proximal tibia. To improve visualization, the lateral approach can be extended with an osteotomy of the femoral epicondyle. In most cases, use of the extended lateral approach allows the whole lateral plateau to be visualized. Nevertheless, in some cases, an osteotomy alone is not enough to expose the entire fracture, especially the central segments of the tibial plateau. For these specific cases, we developed an additional technical trick that significantly improves articular visualization; the lateral meniscocapsular fibers are dissected allowing for central subluxation of the lateral meniscus, while leaving the anterior and posterior roots intact. With central subluxation of the lateral meniscus in comminuted tibial plateau fractures, the joint surface can be completely visualized, allowing an anatomical reduction even in highly complex fractures.

Keywords

collateral ligaments - femoral epicondyle - osteotomy - reconstructive surgical procedures - subluxation of the meniscus - tibial plateau fracture - surgical approach

^* Contributed equally.

Publikationsverlauf

Eingereicht: 19. August 2019

Angenommen: 01. März 2020

Artikel online veröffentlicht:
15. Mai 2020

• References

• 1 Kraus TM, Martetschläger F, Müller D. et al. Return to sports activity after tibial plateau fractures: 89 cases with minimum 24-month follow-up. Am J Sports Med 2012; 40 (12) 2845-2852
• 2 Loibl M, Bäumlein M, Massen F. et al. Sports activity after surgical treatment of intra-articular tibial plateau fractures in skiers. Am J Sports Med 2013; 41 (06) 1340-1347
• 3 Meulenkamp B, Martin R, Desy NM. et al. Incidence, risk factors, and location of articular malreductions of the tibial plateau. J Orthop Trauma 2017; 31 (03) 146-150
• 4 Krause M, Preiss A, Meenen NM, Madert J, Frosch K-H. “Fracturoscopy” is superior to fluoroscopy in the articular reconstruction of complex tibial plateau fractures-an arthroscopy assisted fracture reduction technique. J Orthop Trauma 2016; 30 (08) 437-444
• 5 Krause M, Menzdorf L, Preiss A, Frosch K-H. 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 Orthop 2018; 42 (02) 443-446
• 6 Manidakis N, Dosani A, Dimitriou R, Stengel D, Matthews S, Giannoudis P. Tibial plateau fractures: functional outcome and incidence of osteoarthritis in 125 cases. Int Orthop 2010; 34 (04) 565-570
• 7 Honkonen SE. Degenerative arthritis after tibial plateau fractures. J Orthop Trauma 1995; 9 (04) 273-277
• 8 Parkkinen M, Lindahl J, Mäkinen TJ, Koskinen SK, Mustonen A, Madanat R. Predictors of osteoarthritis following operative treatment of medial tibial plateau fractures. Injury 2018; 49 (02) 370-375
• 9 Chen HW, Liu GD, Wu LJ. Clinical and radiological outcomes following arthroscopic-assisted management of tibial plateau fractures: a systematic review. Knee Surg Sports Traumatol Arthrosc 2015; 23 (12) 3464-3472
• 10 Verona M, Marongiu G, Cardoni G, Piras N, Frigau L, Capone A. Arthroscopically assisted reduction and internal fixation (ARIF) versus open reduction and internal fixation (ORIF) for lateral tibial plateau fractures: a comparative retrospective study. J Orthop Surg Res 2019; 14 (01) 155
• 11 Wang Z, Tang Z, Liu C, Liu J, Xu Y. Comparison of outcome of ARIF and ORIF in the treatment of tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc 2017; 25 (02) 578-583
• 12 Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg Am 2002; 84 (09) 1541-1551
• 13 Softness KA, Murray RS, Evans BG. Total knee arthroplasty and fractures of the tibial plateau. World J Orthop 2017; 8 (02) 107-114
• 14 Kfuri M, Schatzker J, Castiglia MT, Giordano V, Fogagnolo F, Stannard JP. Extended anterolateral approach for complex lateral tibial plateau fractures. J Knee Surg 2017; 30 (03) 204-211
• 15 Krause M, Müller G, Frosch K-H. Chirurgische Zugänge bei Tibiakopffrakturen. Unfallchirurg 2018; 121 (07) 569-582
• 16 Krause M, Frosch K-H. Osteosynthese einer bikondylären Tibiakopffraktur in Bauchlage : Videobeitrag. Unfallchirurg 2018; 121 (12) 1004-1010
• 17 Krause M, Müller G, Frosch K-H. Erweiterter medialer und erweiterter lateraler Zugang bei Tibiakopffrakturen. Oper Orthop Traumatol 2019; 31 (02) 127-142
• 18 Krause M, Krüger S, Müller G, Püschel K, Frosch K-H. How can the articular surface of the tibial plateau be best exposed? A comparison of specific surgical approaches. Arch Orthop Trauma Surg 2019; 139 (10) 1369-1377
• 19 Krause M, Preiss A, Müller G. et al. Intra-articular tibial plateau fracture characteristics according to the “Ten segment classification”. Injury 2016; 47 (11) 2551-2557
• 20 Frosch K-H, Balcarek P, Walde T, Stürmer KM. A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma 2010; 24 (08) 515-520
• 21 Lobenhoffer P, Gerich T, Bertram T, Lattermann C, Pohlemann T, Tscheme H. Spezielle posteromediale und posterolaterale zugänge zur versorgung von tibiakopffrakturen. Unfallchirurg 1997; 100 (12) 957-967
• 22 Bowers AL, Huffman GR. Lateral femoral epicondylar osteotomy: an extensile posterolateral knee approach. Clin Orthop Relat Res 2008; 466 (07) 1671-1677
• 23 Singleton N, Sahakian V, Muir D. Outcome after tibial plateau fracture: how important is restoration of articular congruity?. J Orthop Trauma 2017; 31 (03) 158-163
• 24 Haller JM, O'Toole R, Graves M. et al. How much articular displacement can be detected using fluoroscopy for tibial plateau fractures?. Injury 2015; 46 (11) 2243-2247
• 25 Reul M, Nijs S, Rommens PM, Hoekstra H. Intraartikuläre Tibiakopffrakturen. Z Orthop Unfall 2017; 155 (03) 352-370
• 26 Bin S-I, Nha K-W, Cheong J-Y, Shin Y-S. Midterm and long-term results of medial versus lateral meniscal allograft transplantation: a meta-analysis. Am J Sports Med 2018; 46 (05) 1243-1250
• 27 Bloch B, Asplin L, Smith N, Thompson P, Spalding T. Higher survivorship following meniscal allograft transplantation in less worn knees justifies earlier referral for symptomatic patients: experience from 240 patients. Knee Surg Sports Traumatol Arthrosc 2019; 27 (06) 1891-1899
• 28 Figueroa F, Figueroa D, Calvo R, Vaisman A, Espregueira-Mendes J. Meniscus allograft transplantation: indications, techniques and outcomes. EFORT Open Rev 2019; 4 (04) 115-120
• 29 Heinzmann J, Culemann U, Pohlemann T. Tibiakopffrakturen. Orthopäd Unfallchirur 2007; 2 (05) 377-396
• 30 Tekin AÇ, Çakar M, Esenyel CZ. et al. An evaluation of meniscus tears in lateral tibial plateau fractures and repair results. J Back Musculoskeletal Rehabil 2016; 29 (04) 845-851
• 31 Kolb JP, Regier M, Vettorazzi E. et al. Prediction of meniscal and ligamentous injuries in lateral tibial plateau fractures based on measurements of lateral plateau widening on multidetector computed tomography scans. BioMed Res Int 2018; 2018: 5353820