The Midline Lateral Parapatellar Arthrotomy: A Safe Alternative Approach for Lateral Tibial Plateau Fractures

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Surgical approaches

Background:

• The midline lateral parapatellar (LP) approach may offer superior articular exposure compared to the anterolateral (AL) approach for tibial plateau fractures.
• Previous cadaveric studies suggested improved visualization with the LP approach.

Purpose of the Study:

• To report on the clinical outcomes and complication rates associated with the LP approach in treating lateral tibial plateau fractures.
• To compare the LP approach with the established AL approach.

Main Methods:

• Retrospective comparative cohort study and prospective cohort design.
• Inclusion of adult patients with isolated lateral tibial plateau fractures (OTA/AO 41-B1, 41-B2, 41-B3) undergoing open reduction internal fixation.
• Evaluation of postoperative complications (infection, wound healing, reoperation) and functional outcomes (range of motion, Short Musculoskeletal Function Assessment).

Main Results:

• A total of 81 patients were analyzed (32 LP, 49 AL).
• No significant differences were observed in complication or reoperation rates between the LP and AL groups (P > 0.39).
• The prospective cohort (14 patients) demonstrated a mean knee range of motion of 130 degrees and favorable Short Musculoskeletal Function Assessment scores.

Conclusions:

• The LP approach yields clinical and functional outcomes comparable to the AL approach for lateral tibial plateau fractures.
• The LP approach is a safe alternative surgical technique.
• This approach may be most advantageous for treating comminuted lateral tibial plateau fractures.