Arthroscopic Assisted Reduction and Fixation in Tibial Plateau Fractures: A Prospective Review

Tibial plateau fractures, which constitute approximately 1% of all fractures with an incidence of 10.3/100,000 annually, result from varus or valgus forces combined with axial loading in the knee. These fractures display a bimodal distribution, affecting younger individuals through high-velocity trauma and older individuals through low-energy trauma. Proper management is critical due to the tibial plateau's role as a load-bearing surface; inadequate treatment can lead to functional impairment and early osteoarthritis. Utilizing the Schatzker classification, this study categorizes tibial plateau fractures to streamline treatment and reproducibility.

The objective of the study was to assess the functional and radiological outcomes in the patients operated with arthroscopic assisted reduction and internal fixation (ARIF).

This prospective analytical study conducted at a tertiary care hospital evaluates the functional and radiographic outcomes of 20 patients with Schatzker Type 1-4 tibial plateau fractures treated using ARIF. Patients excluded were those with Schatzker Type 5 and 6 fractures due to the increased risk of compartment syndrome from fluid extravasation during arthroscopy. Surgical procedures aimed to achieve anatomical reduction, proper alignment, stable fixation, early mobilization, and minimal soft-tissue damage.

The study conducted in the cohort which constituted of 20 patients with a mean age of 44.3 years with 9 males and 11 females and fracture distribution being Schatzker 1/2/3/4: 3/5/10/2, respectively, found ARIF advantageous in diagnosing and treating articular cartilage and soft-tissue injuries, minimizing soft-tissue dissection, and reducing the need for extensive arthrotomy. The results demonstrated good to excellent outcomes in 85% of patients, with no depression in 70% of cases and no varus/valgus malalignment in 80% of cases after 18 months. However, the technique posed challenges such as increased operative time and a steep learning curve.

ARIF had favorable radiological and functional outcomes in the patient who was selected after careful evaluation.