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Clinical results after surgical treatment of posterolateral tibial plateau fractures ('apple bite fracture') in combination with ACL injuries
- Source :
- European journal of trauma and emergency surgery : official publication of the European Trauma Society. 46(6)
- Publication Year :
- 2020
-
Abstract
- The anterior cruciate ligament (ACL)-tear is a common injury in orthopaedic trauma. Depending on the energy of impact fractures of the posterolateral tibial plateau are often associated. Different morphologic variants of posterolateral tibial plateau impaction fractures have been described in the setting of an ACL-tear. Up to now an algorithm of treatment for a combined injury of a posterolateral tibial head fracture and an injury to the anterior cruciate ligament is missing. We present a retrospective study with clinical and radiological analysis of posterolateral fractures in combination with ACL-tear. Impressions with a depth of more than 2 mm and/or a width that outreaches more than half of the posterior horn of the lateral meniscus with additional 3. degree positive pivot-shift-test indicated surgical treatment of the fracture with additional ACL repair or reconstruction. Clinical evaluation included follow-up examination, Visual Analog Scale (VAS), International Knee Documentation Committee Score (IKDC), functional and radiological Rasmussen score. 20 patients were included with a mean age of 43.6 ± 12.4 years. Mean follow-up was 18,2 ± 13,5 months. The fracture was arthroscopically reduced and percutaneously fixed with a screw osteosynthesis (Group 1), reduced via a dorsal approach without (Group 2) or with an autologous bone graft (Group 3). Subjective IKDC score was 79,15 ± 6,07. Functional Rasmussen scores ranged from 27 to 30 (mean 28 ± 2.71). Radiological Rasmussen scores ranged from 16 to 18 points (mean 16.75 ± 1.33). According to IKDC score (p = 0.60), functional Rasmussen score (p = 0.829) and radiological Rasmussen score (p = 0.679) no significant discrepancy between the groups were seen. There was no failure of the ACL graft recorded. Posterolateral tibial plateau fractures in combination with an ACL-tear, can cause persistent instability and increase rotational instability. Indication for treatment of these fractures is still under debate. From the biomechanical aspect the lack of more than 50% of the posterior horn of the lateral meniscus and dislocation/depression of more than 2 mm results in an increased rotational instability of the ACL deficient knee. Combined surgical treatment with ACL repair or reconstruction is a safe procedure that results in good, short-term clinical outcome, if our algorithm is followed. In addition this study shows, that majority of posterolateral tibial plateau fractures can be treated arthroscopically.
- Subjects :
- Joint Instability
Male
medicine.medical_specialty
Sports medicine
Knee Joint
Visual analogue scale
Anterior cruciate ligament
Bone Screws
Critical Care and Intensive Care Medicine
Arthroscopy
Fracture Fixation, Internal
medicine
Humans
Orthopedics and Sports Medicine
Retrospective Studies
Lateral meniscus
Osteosynthesis
Bone Transplantation
Impaction
business.industry
Anterior Cruciate Ligament Injuries
Retrospective cohort study
Recovery of Function
Middle Aged
musculoskeletal system
Surgery
Tibial Fractures
medicine.anatomical_structure
Radiological weapon
Emergency Medicine
Female
business
Subjects
Details
- ISSN :
- 18639941
- Volume :
- 46
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- European journal of trauma and emergency surgery : official publication of the European Trauma Society
- Accession number :
- edsair.doi.dedup.....1727daead17e0941193de2382961475b