Abstract
Introduction Following any intraarticular fracture, joint range of movement and muscle strength recovery are vital factors in patient’s return to activities. Quadriceps weakness is a known complication of any injury affecting the knee. The purpose of this study was to investigate the recovery of knee ROM and quadriceps and hamstrings muscle strength in the first year after tibial plateau fracture and to assess factors that affect the recovery.
Method 63 patients were recruited over a 5-year period. Data regarding the age and sex of the patient, the mechanism of injury, the grade of the fracture according to Shatzker’s classification and the treatment received were recorded. All patients underwent a standard rehabilitation regime. At 3, 6 and 12 months after injury the patients were seen by a research physiotherapist. The range of movement was recorded. Thigh muscle peak torque was measured using isokinetic dynanmometry. The uninjured limb was used as the control – the peak torque in the injured limb was expressed as a percentage of the value in the uninjured limb to give the percentage recovery in the injured limb.
Results There was an initial extension deficit of 7° at 3 months, which improved to 3° at 12 months. Quadriceps strength recovery lagged behind that in the hamstrings at all times and only achieved only 77% at 12 months, compared to 90% in the hamstrings (p< 0.001). Patients under 40 outperformed those over 40 at each time point. At 12 months under 40s had achieved 85% recovery in their quadriceps, while over 40s only reached 74% (p< 0.01). Patient sex, mechanism of injury and grade of fracture had no effect on the level of recovery in this study.
Conclusion Patients who sustain a tibial plateau fracture have a residual small extension deficit and objective quadriceps weakness at 1 year post injury. Patient age has a significant effect on the level of quadriceps recovery. This information is useful when counselling patients who sustain these injuries.
Correspondence should be addressed to Roger Smith, Honorary Secretary, BASK c/o Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, London WC2A 3PN
