Difficulties in Treating Complex Knee Injuries with Fracture of Posterior Tibial Plateau

Abstract

Background. The aim of the study was to assess the outcomes of surgical treatment of complex knee injuries with a posterior inverted-L approach to the knee joint. Material and methods. The study retrospectively enrolled 13 patients who underwent surgical treatment due to knee injuries with posterior tibial plateau fractures in 2015-2017. Pre-operative planning was based on antero­po­sterior and lateral X-rays and CT images. The fracture was assessed according to Luo’s three-column classification. Radiographic postoperative assessment was based on lower limb (standing) X-rays and measurements of the MPTA, aPPTA, JLCA, and aFaT angles in the operated and healthy limbs. Clinical assessment was based on the IKDC, KOOS, and Tegner-Lysholm Knee Scoring Scale. Results. Mean follow-up duration was 11.5 months (4-25 months). Anatomical joint surface reduction was achiev­ed in 12 patients and bone union was present in all patients. A posterior inverted-L approach was used in 9 pa­tients and combined approaches in 8 patients. According to the three-column classification, single-column fractures were found in 3 patients, two-column fractures in 4, and three-column fractures in 6 patients. The KOOS was 82%, the IKDC score was 80%, and the Tegner-Lysholm score was 82 points. Radiographic assessments of the operated knee joints showed an MPTA of 88.64 degrees, aPPTA of 79.78 degrees, JLCA of 0.8 degrees, and aFaT of 7.9 degrees. Conclusions. 1. Anatomical reduction and stable fixation of posterior plateau fractures of the proximal tibia are crucial in fracture management. 2. A posterior inverted-L approach is very useful when treating posterior tibial plateau fractures.