Patellar Tendon Z-plasty Approach for Comminuted Tibial Plateau Fractures

Introduction This study aims to describe the surgical technique and evaluate the functional and radiological outcomes of comminuted tibial plateau fractures treated using the patellar tendon Z-plasty approach. Materials and methods A retrograde analysis was conducted with clinical and radiological data on nine patients from 2011 to 2025 with an average age of 42 years (range, 20-70 years) who were admitted for tibial plateau fractures with significant comminution involving the intercondylar area and/or the posterior parts of the condyles. Surgery was performed using a midline incision with patellar tendon Z-plasty. This technique provides full visibility to the proximal tibia and makes anatomic reduction easier under direct vision. Results Patients were followed up for an average of 5.3 years (range, 0.5-11 years). No problems with the extensor mechanism were encountered. The range of motion at the final follow-up was normal (0^o-140^o), with only one patient developing a fixed flexion contraction of 8^o due to severe posttraumatic osteoarthritis. Assessment of the knee joint function at the final follow-up was conducted using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Conclusion Patellar tendon Z-plasty is a safe approach that can be used in comminuted plateau fractures. It makes anatomic reduction easier under direct vision, through a single anterior incision, while having excellent postoperative results.