Poor sporting abilities after tibial plateau fractures involving the posterior column: how can we do better?

Abstract

Purpose Tibial plateau fractures with the involvement of the posterior column are an important prognostic factor towards poor functional outcome. We aimed to assess the sporting abilities postoperatively with special emphasis on the type of sports and sport-specific movements, as well as time needed to resume sports, restricting factors in sports engagement, and patient satisfaction. We aimed to provide prognostic information on return to sports. Methods Demographic, clinical and radiological variables were retrospectively collected from 82 multicentric patients between 2014 and 2016. Prospectively, sporting abilities before and after surgery were determined using questionnaires at a mean follow-up of 33 months postoperatively. Results Involvement in sports significantly decreased, with only 68.4% of patients resuming sports (p < 0.001). The mean time needed to partially or fully resume sports was 6-9 and 9-12 months, respectively. The ability to resume at the pre-injury level of effort and performance was 22% and 12%, respectively. Restricting factors were pain (66%), fear of re-injury (37%), limited range of motion (26%), and instability (21%). The majority (59%) of patients were unsatisfied with their physical abilities. Significantly worse outcomes were observed in patients playing high-impact sports, experiencing knee pain during physical activity, suffering from extension/valgus or flexion/varus trauma. Conclusions Tibial plateau fractures with the involvement of the posterior column significantly hamper the patients' sporting abilities, leaving the majority of patients unsatisfied. Preoperative counseling about prognosis, setting realistic expectations, optimizing rehabilitation and pain management postoperatively, and advising low-impact sports might improve engagement in physical activities and emotional impact on patients. Level of evidence 3.

Physiotherapy after tibial plateau fracture fixation: A systematic review of the literature

“…Less than 1 in 5 patients return to pre-injury levels of activity with reported main issues such as pain, knee joint stiffness, instability and fear for re-injury. 40 This fact illuminates the need for ongoing rehabilitation of these patients, in order to try to improve the patients’ satisfaction and level of activity.…”

Tibial Plateau Fracture

“…A special consideration must be taken for posterior plateau fragments which may not be adequately buttressed by medial or lateral plating. Involvement of the posterior segment has been shown to be more prevalent than previously recognized and failure to identify and manage it has been associated with misalignment and functional instability [22,32,100]. This could also be one of the reasons for failure in some fractures that still collapse secondarily after fixation [98,101].…”

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

“…Nonetheless, persistent pain, impaired range of motion (ROM), and/or instability are repeatedly described. While short-and mid-term outcomes have been associated with a low return-to-sports rate and a low patient-related outcome compared to healthy individuals (Knee Injury and Osteoarthritis Outcome Score), a good-toexcellent knee function in the long term has been reported (Rasmussen and Hospital for Special Surgery Knee Scoring System) [6][7][8][9][10]. Several studies have identified potential fracture-specific and surgery-related risk factors for impaired patient outcomes [6][7][8][9][10][11].…”

“…While short-and mid-term outcomes have been associated with a low return-to-sports rate and a low patient-related outcome compared to healthy individuals (Knee Injury and Osteoarthritis Outcome Score), a good-toexcellent knee function in the long term has been reported (Rasmussen and Hospital for Special Surgery Knee Scoring System) [6][7][8][9][10]. Several studies have identified potential fracture-specific and surgery-related risk factors for impaired patient outcomes [6][7][8][9][10][11]. As a result, there is general consensus that anatomical reconstruction within a 2-3-mm articular step-off, a straight leg axis, and stable bony and ligamentous fixation should be considered [9,[11][12][13][14].…”

“…While some studies have also analyzed the influence of patient-specific risk factors, medication, or comorbidities, their association with bone metabolism and its impact on patient outcomes has not been in the focus [6,7,10,[15][16][17]. Instead, impaired bone metabolism (IBM) and its association with patient-specific risk factors such as vitamin D deficiency, thyroid dysfunction, chronic kidney disease (CKD) or liver failure, systemic immunodeficiency after organ transplantation or with HIV, or osteoporosis itself have most commonly been studied in relation to fracture risk of vertebral and hip fractures.…”