Return to Skiing After Proximal Tibial Fracture: Postoperative Reality and Initial Expectations

Background/Objectives: The aim of this study was to investigate patient-reported outcomes of patient expectations and fulfillment of expectations in alpine skiers who had a skiing accident and suffered a complex proximal tibial fracture (AO/OTA-Type B or C) which was treated surgically with open reduction and internal fixation. Methods: In this prospective study, 38 consecutive patients who suffered a complex tibial fracture (AO/OTA-Type B and C) caused by a skiing accident were evaluated. Before surgical treatment with open reduction and internal fixation, patient expectations were evaluated regarding outcomes on knee functionality (e.g., pain) and the return to skiing. At follow-up ≥ 1 year after surgery, an individualized questionnaire was used to evaluate whether their preoperatively formulated expectations had been fulfilled (rated 0-2). In addition, the Knee injury and Osteoarthritis Outcome Score (KOOS), and SF-12 was used. Results: Preoperatively, 76% (n = 29) of patients stated that it was "not so important" to be able to return to their initial skiing level, 50% (n = 19) of patients did not expect to be able to ski again, 34% (n = 13) expected to return to skiing at a significantly lower level, and 16% (n = 6) expected to return to skiing with minor restrictions at most. Postoperatively, the return to skiing rate on initial level was 32% (n = 12); 50% (n = 19) stated that their initial skiing level was not reached again but they were able to ski with moderate restrictions, 10% (n = 4) patients stated that no return to skiing was possible, 50% (n = 19) stated that their expectations were fully met, and n = 7 (18%) stated that their preoperative expectations were not met at all. The mean SF-12 physical component score (PCS) was 52, and the mean mental component score (MCS) was 49.9. The mean Numeric Rating Scale (NRS) was 2.3. The mean KOOS for pain was 86.1 (SD 17.1), for symptoms 62.2 (SD 12.9), for ADL 90.7 (SD 14.4), for sports 74.2 (SD 25.7), and for quality of life (QOL) 66.6 (21.0). Conclusions: After suffering from a complex proximal tibial fracture (AO/OTA-Type B or C) in a skiing accident, preoperative patient expectations to return to skiing is limited. This patient-reported outcome of patient expectations was confirmed by the findings of the patient-reported fulfillment of expectations at least one year after surgery as only 32% of patients returned to their initial skiing level, 50% returned to skiing with limitations, and 50% of patients did not meet their preoperative expectations to return to alpine skiing. The results of this study emphasize the importance of directing patients towards realistic expectations by managing the patients' understanding of the severity of their injury and realistic outcomes, and providing realistic forecasts of postoperative outcomes.