Clinical outcome in tibial plateau fractures improves over time: Insights from a collaborative data network

There is a strong demand for research on the long-term outcomes of tibial plateau fractures (TPFs) in large cohorts. Stringent data protection regulations and high ethical standards are essential for safeguarding participants' rights, but they can increase the logistical complexity of conducting multicentre studies. This study aims to evaluate clinical outcome data collected over more than a decade through a collaborative data network in surgically treated TPFs.

This retrospective cohort study was conducted at two level-I trauma centers and included 364 adult patients with operatively TPFs, classified according to the Schatzker system. Eligible patients were treated between January 2010 and September 2022, were ≥18 years of age at the time of injury, resided in Germany, and had a minimum follow-up of 1.25 years with completed patient-reported outcome measures. Patients with cognitive or physical impairments preventing survey participation were excluded. Data collection occurred between September 2022 and January 2023. Outcome measures included the International Knee Documentation Committee (IKDC) form, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Lysholm Score. Multiple linear regression was used to assess associations between outcome scores, follow-up duration, and Schatzker classification.

Longer follow-up times were associated with significantly higher scores for IKDC (p < 0.05), KOOS Pain (p < 0.05), Activities of Daily Living (ADL) (p < 0.05), Sports (p < 0.05), and Quality of Life (QoL) (p < 0.00001). Complex fractures (Schatzker IV-VI) were consistently linked to worse outcomes, particularly in the KOOS Sports (p < 0.001) and Quality of Life (p < 0.00001) subscores. Adjusted R-squared values ranged from 2 % to 10 %, with the highest values observed in KOOS QoL scores.

Patient-reported outcomes (PROMs) were found to be positively associated with longer follow-up durations, up to 12 years postoperatively emphasizing the need for prolonged aftercare in TPFs. Complex fractures, in particular, might benefit from tailored, long-term follow-up. Given the severity of TPFs, it is crucial to manage patient expectations and address psychosocial factors to optimize the outcome. Collaborative data networks, like the one used here, hold promise for expanding research and improving treatment strategies across multiple centers.