Knee Stiffness After Tibial Plateau Fractures: Predictors and Outcomes (OTA-41)

Abstract

Objectives: What patient characteristics and injury factors predict decreased knee range of motion (ROM) after operative management of tibial plateau fractures? Design: Prospective cohort study. Setting: Academic medical center. Patients: Over 11 years, tibial plateau fractures at a single academic institution were prospectively followed. A total of 266 patients were included in this study. Intervention: Surgical repair of tibial plateau fractures and secondary interventions due to arthrofibrosis. Main outcome measure: Clinical outcomes were evaluated using the Short Musculoskeletal Function Assessment and ROM at 3-month, 6-month, and long-term follow-up. Secondary outcomes were considered as the need for a subsequent procedure due to arthrofibrosis. Results: At 3-month follow-up, the mean ROM was 113 degrees. By long-term follow-up (mean = 17 months), the mean ROM improved to 125 degrees. Independent predictors of decreased knee ROM were the following: at 3-month follow-up, open fractures (P = 0.047), application of a knee-spanning external fixator (P = 0.026), orthopaedic polytrauma (P = 0.003), and tibial spine involvement (P = 0.043); and at long-term follow-up, nonwhite ethnicity (P = 0.003), increasing age (P = 0.003), and a deep infection (P = 0.002). Ten patients (3.7%) required a secondary procedure for arthrofibrosis. There was a significant improvement in the knee ROM (P < 0.001) and functional outcomes (P = 0.004) following the intervention. Conclusions: At long-term follow-up, independent predictors of decreased knee ROM were nonwhite ethnicity, increasing age, and sustaining a postoperative complication of a deep infection. Secondary interventions were reliable treatments for arthrofibrosis. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Bone metabolism is a key factor for clinical outcome of tibial plateau fractures

“…The most important risk factor is time spent on the external fixator and bicondylar fracture involvement, which is supported by the present results [53]. Hence, limited ROM in TPF is common and should be the focus of postoperative rehabilitation [53,54].…”

Incidence and risks for surgical site infection after closed tibial plateau fractures in adults treated by open reduction and internal fixation: a prospective study

“…By far, ORIF is the most common treatment choice, which aims at anatomical reduction of fractures and restoration of the lower limb force line. However, there were many potential complications of surgical treatment after tibial plateau fracture, including SSI, joint stiffness, traumatic osteoarthritis, delayed, or non-union [ 2 – 4 ]. Among the complications, SSI was the most common one.…”

Tibial Plateau Fracture

“…They have an annual incidence of 10.3 per 100,000 [5]. The combined incidence of a patient having a tibial plateau fracture with associated polytrauma on admission has been estimated at 16-40% [6][7][8]. The age distribution is bimodal for both males and females which is similar to what is seen in other periarticular injuries [1].…”