An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries

Abstract

High-energy anterior cruciate ligament (high-energy ACL) injury, occurring in high-energy rotatory trauma of the knee, can accompany a unique fracture pattern that involves depression of the slope of the posterolateral tibial plateau (PLTP). These injuries are challenging to manage due to the lack of a gold-standard arthroscopic procedure that addresses both ACL deficiency and depressed PLTP slope. In such injuries, a one-stage approach may be used to (1) reconstruct the ACL or (2) reduce and fix the avulsed tibial spine, while concomitantly performing an arthroscopy-assisted reduction of a PLTP fracture that restores the anatomic slope of the tibial plateau. To summarize, using combined arthroscopic and fluoroscopic visualization, a tibial tunnel reaching 1 cm distal to the depressed plateau fragment is created using a cannulated drill. The drill is used to punch up the depressed fragment to its anatomic location, restoring the original slope of the PLTP. The corrected slope is then fixed in situ using a press-fit fibular allograft to stabilize the corrected PLTP slope. Use of this minimally invasive arthroscopic technique to restore the PLTP slope may help prevent graft failure of the reconstructed ACL and improve patient outcomes.

Extent of posterolateral tibial plateau impaction fracture correlates with anterolateral complex injury and has an impact on functional outcome after ACL reconstruction

“…The correct algorithm for treating these cases is, therefore, still unclear. This study’s relevance, however, lies in that high-grade TPIF should raise awareness of potentially increased rotational instability after ACL reconstruction and, therefore, trigger concurrent ALC reconstruction or TPIF fracture fixation [ 29 ].…”

Incidence and Characteristics of Knee Ligament and Meniscal Injuries in Patients With Posterolateral Tibial Plateau Fractures

“… 1 , 25 However, some case reports have illustrated the technical feasibility of simultaneous surgical management of PTPF and ACL tear. 12 , 21 , 35 Menzdorf et al 17 reported that surgical treatment of PTPF combined with ACL repair or reconstruction is a safe procedure and reported good short-term clinical outcomes in a limited sample of patients. Moreover, specific types of PTPF combined with ACL tear have been noted to affect not only pivot-shift laxity under anesthesia but also the postoperative outcomes of ACL reconstruction.…”

Arthroscopic-Assisted Reduction of Depressed Lateral Tibial Plateau Fracture Using Precision Drill Guide and Fresh-Frozen Femoral Head Allograft

“…Later, Park et al. 9 described an arthroscopic treatment of concomitant ACL injury and depressed posterolateral tibial plateau fracture. The reduced fracture is then fixed in situ using a press-fit fibular allograft to stabilize the depressed fracture.…”

“…Several surgical techniques have been reported to fix the depressed lateral tibial plateau fractures, including open, fluoroscopic-assisted, and arthroscopic-assisted techniques. 1 , 5 , 6 , 7 , 8 , 9 We propose an arthroscopic-assisted reduction of depressed lateral tibial plateau fractures using an ACL tibial drill guide and a fresh-frozen femoral head allograft.…”