Introduction: tibial plateau fractures are a therapeutic challenge that are increasingly being dealt with arthroscopically assisted surgical treatment. About 40% of cases associate a meniscal lesion. Meniscal repair is a challenging technique in this setting but has an increased importance due to the intrinsic role as cartilage protector of the meniscus. Although suture in the course of the reconstructive procedure is more technically demanding and time consuming the biological surrounding of the repair is optimal (extensive intraarticular bleeding, prolonged non weight-bearing, presence of bone marrow elements, acute repair).

The objective of this study is to determine the outcomes of meniscal suture in this group of patients.

Material and methods: Between 1999 and 2007 sixty one tibial plateau fractures were operated with arthroscopic assistance in our institution. Of these, 25 presented meniscal injuries and 16 of these were repaired. Repair criteria were: no age limit was established and all types of ruptures (even radial or bird-beak lesions) were repaired if technically possible. 14 external menisci and 2 internal menisci were repaired. Morphologically 15 were longitudinal ruptures in the red-red zone and one was a bird beak rupture. Suture was performed using a combination of repair techniques including outside-inside (seven cases), inside-outside (two cases) and all-inside (14 cases). Functional results were evaluated with the following scales: Rasmussen, Honkonen, ICDK, Lysholm, SF-36 and Knee Society scores. Evaluation of the meniscal repair was performed either by M.R.I. of the knee (obtained in six cases) or arthroscopic revision of the meniscal repair (during surgery for implant removal in 9 cases). In one case the patient required a TKA not related to the meniscal lesion and the meniscus was revised during the procedure.

Results: All cases were available for follow up a minimum of 12 months after surgery (mean 2.6 +/−1.4 years). Functional results were excellent or good in 14 of 16 cases. One poor result was related to meniscal symptoms and requiered arthrocopic meniscectomy, the other poor result was due to arhtrofibrosis. Direct visual revision of the suture (either arthroscopically [9 cases] or during open surgery [one case]) allowed for the diagnosis the symptomatic failure of the repair and of complete healing in the rest of cases (9). MRI showed complete repair in four cases, partial repair in one and failure in one; all being asymptomatic.

Conclusions: this technique seems to offer good results with complete healing observed in 81% of cases and partial healing in 6%; symptomatic failure of the repair was observed only in 6% of the cases. In meniscal injuries related to this type of fracture, repair should be always considered as the biological environment seems to facilitate success in the repair.

Objectives: tibial plateau fractures are a therapeutic challenge for the trauma surgeon. Arthroscopically assisted surgical treatment (AT) is an option in these fractures that is used more and more frequently even in more complex lesions. The objective of this study is to determine if, at a minimum 1 year follow up, arthroscopic treatment is comparable to open treatment (OT) in respect to radiologic and functional outcomes.

Materials and Methods: We have prospectively reviewed our first 50 arthroscopic cases and compared them with 50 open surgery cases examined retrospectively. The cases in the second group were selected from a database of 87 patients and were matched for Schätzker type, degree of displacement, age and sex with cases of the first group. In each group there were 50 patients (33 male/17 female; mean age: 45,4 years in the AT group and 43,6 years in the OT group). Of the 50 cases in each group, ten were Schätzker I tibial plateau fractures, sixteen were type II, seven type III, eleven type IV, three type V and three type VI. In the AT group all fractures were reduced and fixated with cannulated screws under direct arthroscopic control and in 6 cases a percutaneous plate was added. In the OT group all fractures were reduced and fixated with cannulated screws under direct vision (n=41) or radiologic control (n=9) and in 37 cases a plate was added. Associated lesions were identified and treated accordingly in both groups. Results were evaluated with the following scales: Rasmussen, Honkonen, ICDK, Lysholm, SF-36 and Knee Society scores.

Results: All cases were available for follow up a minimum of 12 months after surgery (2.6 +/−1.4 years in AT and 3.7+/−1.5 years in OC). The patients in the AT group had lower hospital stances (p< 0.05) and lesser postoperative wound complications (zero versus 3). Radiological reduction and alignment was considered excellent or good in 92% of AT cases and 88% of OT cases. Knee society scores were 191+/−18 in AT and 176+/−21 in OT. Lysholm scale scores were 85+/−20 in AT and 72+/−21 in OT. Rasmussen scale scores were 29+/−2.2 in AT and 26+/−3.9 in OT. Most of the differences between both groups was related to range of motion but pain scores were similar.

Conclusions: Arthroscopically assisted treatment of tibial plateau fractures seems to offer better results than open surgery with less hospital stay, lesser postoperative complications and clearly improved range of motion. It can be considered an adequate alternative to traditional open reduction and fixation even in complex fractures.