Fractures Around the Knee-Significant Achievements During the Past 25 Years and Major Questions to Be Solved

Background: Over the past 25 years, advances in knee surgery have been driven by an improved understanding of fracture morphology and associated injuries, as well as by significant technological progress. The introduction of novel classification systems has led to the refinement of treatment strategies, particularly with respect to the selection of surgical approaches. Furthermore, advances in biomechanical understanding have facilitated the development of new osteosyntheses designed to promote earlier rehabilitation while simultaneously reducing complication rates. Research Question: Which key milestones over the last 25 years have significantly influenced treatment strategies for knee joint fractures, with a perspective on unresolved issues? Results: Recent advances in fracture management, osteosynthesis, imaging techniques, and biomechanical research have substantially improved clinical outcomes, including a reduction in infection rates and improved postoperative results. The implementation of new classification systems has enabled more precise preoperative planning, allowing surgeons to define approaches that ensure adequate visualization of the articular surface while facilitating optimal positioning of the osteosynthesis. In terms of osteosynthesis, the introduction of locking plate technology has become widely established and supported by biomechanical evidence and has largely replaced traditional methods such as tension-band wiring of the patella. Despite these advances, fracture management in geriatric patients remains a considerable challenge, as compromised bone quality frequently limits the ability to achieve sufficiently load-stable osteosynthesis. Direct visualization of the articular surface is essential for adequate assessment and reduction of the affected articular segment. However, there is currently no consensus on which surgical approach or possible extension is most appropriate while simultaneously ensuring a low complication rate.