Vol.:(0123456789) 1 3 Knee Surgery, Sports Traumatology, Arthroscopy https://doi.org/10.1007/s00167-018-5122-0 KNEE A sub-meniscal arthrotomy improves the medium-term patient outcome of tibial plateau fractures Richard E. Buckley 1  · Prism Schneider 1  · Paul J. Dufy 1  · Shannon Puloski 1  · Robert Korley 1,2  · C. Ryan Martin 1 Received: 5 March 2018 / Accepted: 22 August 2018 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018 Abstract Purpose This trial was conducted to determine the medium-term functional outcome of displaced tibial plateau fracture patients treated with closed fuoroscopic assisted reduction and internal fxation (CRIF) versus patients treated with standard open reduction with sub-meniscal arthrotomy and internal fxation (ORIF). Methods A prospective trial was conducted in adult patients with displaced AO/OTA 41 B and 41 C tibial plateau fractures. Patients were assigned to treatment based upon the standard treatment of the surgeon involved following the call schedule for the day, either CRIF or ORIF. Postoperative radiographs and CT were performed on all patients and patients were followed for a minimum of 2 years. Primary outcome measures were the KOOS, SMFA and SF-36. Results Seventy patients were recruited with 2 year follow-up on 35 patients in the CRIF group and 27 patients in the ORIF group. Postoperative CT scans showed that reductions were better with the ORIF group especially in the posterolateral quadrant as compared to the CRIF group. The frequency of mal-reductions was higher in the CRIF group. The KOOS, at two years, showed that the CRIF had signifcantly less good outcomes in the subcategories of SPORT (p = 0.03) and QOL (p = 0.01) measurements. Conclusions ORIF with a sub-meniscal arthrotomy provides better quality reductions and better medium-term results as compared to CRIF for tibial plateau fractures. This may provide more long-term beneft from osteoarthritic symptoms in this patient group. Level of evidence Therapeutic, Level 2. Keywords Tibial plateau · Fractures · Open reduction internal fxation · Submeniscal arthrotomy · Functional outcome Introduction Tibial plateau fractures (TPF) account for 1% of all fractures with a wide spectrum of soft tissue injuries accompanying these fractures [4]. Over the last two decades, there has been a trend towards less invasive techniques [19] in orthopedic trauma practice [10]. Some surgeons have stated that less dissection leads to better functional outcomes for the treat- ment of high energy TPFs possibly with arthroscopy [9]. In this fracture, a strong correlation between an accurate articular reduction [3] and higher functional outcome [6] has been previously reported. Visualization of the damaged articular surface, especially of the posterolateral tibial plateau can be difcult. There is information about long-term functional outcomes of opera- tively treated TPFs [11, 14], but prospective data on ORIF with sub-meniscal arthrotomy or other less invasive tech- niques is lacking. Some authors have used fxation without * Richard E. Buckley buckclin@ucalgary.ca Prism Schneider prism.schneider@gmail.com Paul J. Dufy pauljdufy@mac.com Shannon Puloski spuloski@ucalgary.ca Robert Korley korley2010@gmail.com C. Ryan Martin cryanmartin@gmail.com 1 0490 McCaig Tower, 3134 Hospital Drive NW, Foothills Medical Center, University of Calgary, Calgary, AB T2N 5A1, Canada 2 Suite 335 401-9th Ave SW, Calgary AB T2P 3C5, Canada