New research in the March 2018 edition of the Journal of Orthopaedic Trauma has found that when it comes to tibial plateau fracture fixation, ligament ruptures did not significantly affect clinical outcomes. The study was entitled, “The Effect of Soft Tissue Injuries on Clinical Outcomes After Tibial Plateau Fracture Fixation.”
Linking Soft Tissue Injuries to Fracture Fixation Outcomes
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Stephen J. Warner, M.D., Ph.D., with the Orthopaedic Trauma Service at the University of Texas Health Science Center at Houston and co-author on the study, commented to OTW, “Previous studies have demonstrated high rates of associated ligamentous and meniscal injuries with tibial plateau fractures, but the clinical relevance of those injuries was unknown. The goal of our study was to better define how these associated injuries alter clinical outcomes in these patients.”
“The series includes patients with tibial plateau injuries who had pre-operative knee MRIs [magnetic resonance imaging] to define their soft tissue injuries as well as patient-reported outcomes to assess their functional recovery. We also reported on the rate of secondary surgeries these patients required to address these soft tissue injuries in a delayed fashion.”
“In this cohort of patients with operative tibial plateau fractures, sutured lateral meniscal tears, untreated medial meniscus tears, and complete MCL [medial collateral ligament] ruptures did not significantly affect clinical outcomes. In addition, subsequent secondary surgeries in these patients was rare.”
“These data suggest that obtaining a preoperative MRI in patients with tibial plateau fractures to diagnose soft tissue injuries may not alter the surgical treatment or alter patient prognosis for midterm outcomes.”
“As with all surgical decision making, the surgeon’s clinical examination and intuition should dictate treatment. This is especially important considering certain limitations of MRI in detecting degrees of ligamentous injuries around the knee.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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