Lateral articular line versus extended anterolateral approach for Schatzker type II-III tibial plateau fractures

ObjectiveTo compare the radiological and functional outcomes of the newly proposed lateral articular line approach with those of the traditional extended anterolateral approach in the management of Schatzker type II-III tibial plateau fractures involving the posterolateral quadrant.MethodsThis single-center retrospective cohort study included 90 patients who underwent open reduction and internal fixation using either lateral articular line approach (n = 45) or extended anterolateral approach (n = 45). Perioperative data (operative time, blood loss, and incision length), radiological outcomes (articular depression and posterior tibial slope), and functional recovery (Rasmussen knee scores and range of motion) were evaluated up to 12 months postoperatively.ResultsCompared with the extended anterolateral approach, the lateral articular line approach significantly reduced operative time (72.47 vs. 87.73 min, p < 0.001), blood loss (80.11 vs. 133.33 mL, p < 0.001), and incision length (6.0 vs. 15.0 cm, p < 0.001). The lateral articular line approach also achieved better reduction quality with smaller final articular depression (0.55 vs. 1.55 mm, p < 0.001) and yielded higher Rasmussen knee scores and greater range of motion at all follow-up assessments (all p < 0.05). Complication rates were comparable between the two groups.ConclusionThe lateral articular line approach offers a minimally invasive and reliable alternative to the extended anterolateral approach for Schatzker type II-III tibial plateau fractures with posterolateral involvement, providing superior reduction quality, faster recovery, and less surgical trauma.