Radiographic Osteoarthritis and Patient-Reported Outcomes One Year Following Tibial Plateau Fracture Surgery

This study aimed to characterize early clinical, functional, and radiographic outcomes after surgical treatment of tibial plateau fractures and to identify independent predictors of moderate-to-severe post-traumatic knee osteoarthritis (Kellgren-Lawrence (KL) grades 3-4) at 12 months, with emphasis on the relative contribution of fracture morphology and radiographic osteoarthritis severity.

We conducted a retrospective analysis of prospectively collected clinical data from consecutive adults who underwent open reduction and internal fixation of tibial plateau fractures at a tertiary trauma center between March 2017 and June 2025, with twelve-month follow-up completed by mid-2026. Fractures were classified using the Schatzker system. At 12 months, patients underwent standardized clinical and imaging follow-up, including Rasmussen clinical and radiologic scores, KL grading, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the 36-Item Short Form Health Survey (SF-36) physical and social functioning domains. Group comparisons between KL grades 0-2 and 3-4 were conducted using non-parametric tests. Multivariable logistic regression identified predictors of KL grades 3-4, and multivariable linear regression explored correlates of KOOS and SF-36 physical functioning.

Of 109 eligible patients, 106 (median age 43 years; 57.5% male) completed the 12-month evaluation. High-energy patterns predominated, with Schatzker types V-VI accounting for 51.8% of fractures. Median KOOS was 77; median SF-36 physical and social functioning scores were 80 and 88.5, respectively. While 80.2% of knees had KL grades 0-2, 19.8% already exhibited grades 3-4 and showed lower KOOS (median 63 vs 79) and lower SF-36 physical functioning (median 70 vs 82). In multivariable models, older age and female sex independently predicted KL grades 3-4, whereas fracture complexity did not. Moderate-to-severe osteoarthritis was the only variable independently associated with worse knee-specific and general physical function, corresponding to mean reductions of approximately 13 points in KOOS and 15 points in SF-36 physical functioning. No variable independently predicted Rasmussen clinical category.

Most patients achieved satisfactory short-term outcomes after tibial plateau fracture surgery, yet nearly one-fifth exhibited moderate-to-severe radiographic osteoarthritis at the latest follow-up with clinically meaningful functional decrements. The Schatzker classification did not independently predict these outcomes, whereas early KL grades 3-4 emerged as the strongest correlate of functional impairment. Systematic integration of radiographic osteoarthritis grading with validated patient-reported outcome measures is essential for risk stratification and longitudinal follow-up planning.