Clinical results after surgical treatment of posterolateral tibial plateau fractures ("apple bite fracture") in combination with ACL injuries.
Purpose: The anterior cruciate ligament (ACL)-tear is a common injury in orthopaedic trauma. Depending on the energy of impact fractures of the posterolateral tibial plateau are often associated. Different morphologic variants of posterolateral tibial plateau impaction fractures have been described...
| Publicado en: | European Journal of Trauma & Emergency Surgery Vol. 46; no. 6; pp. 1239 - 1249 |
|---|---|
| Autores principales: | , , , , , , , , |
| Formato: | algorithm diagnostic images research tables/charts Journal Article |
| Publicado: |
Springer Nature
2020
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=147225384&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 147225384 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18639933 3C05 jtl: European Journal of Trauma & Emergency Surgery issn: 18639933 maglogo: N pubinfo: dt: 2020 vid: 46 iid: 6 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 147225384 146071682 147225384 147225384 10.1007/s00068-020-01509-8 147225384 ppf: 1239 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Clinical results after surgical treatment of posterolateral tibial plateau fractures ("apple bite fracture") in combination with ACL injuries. aug: au: Menzdorf, Leif Drenck, Tobias Akoto, Ralf Hartel, Maximilian Krause, Matthias Guttowski, Dario Barg, Alexej Frosch, Karl-Heinz Kolb, Jan Philipp affil: Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany sug: subj: Tibial Plateau Fracture Surgery Anterior Cruciate Ligament Injuries Surgery Anterior Cruciate Ligament Reconstruction Methods Treatment Outcomes Human Retrospective Design Fracture Fixation Methods Scales Adult Middle Age Orthopedic Fixation Devices Bone Transplantation Joint Instability Arthroscopy Adult: 19-44 years Middle Aged: 45-64 years ab: Purpose: The anterior cruciate ligament (ACL)-tear is a common injury in orthopaedic trauma. Depending on the energy of impact fractures of the posterolateral tibial plateau are often associated. Different morphologic variants of posterolateral tibial plateau impaction fractures have been described in the setting of an ACL-tear. Up to now an algorithm of treatment for a combined injury of a posterolateral tibial head fracture and an injury to the anterior cruciate ligament is missing. Methods: We present a retrospective study with clinical and radiological analysis of posterolateral fractures in combination with ACL-tear. Impressions with a depth of more than 2 mm and/or a width that outreaches more than half of the posterior horn of the lateral meniscus with additional 3. degree positive pivot-shift-test indicated surgical treatment of the fracture with additional ACL repair or reconstruction. Clinical evaluation included follow-up examination, Visual Analog Scale (VAS), International Knee Documentation Committee Score (IKDC), functional and radiological Rasmussen score. Results: 20 patients were included with a mean age of 43.6 ± 12.4 years. Mean follow-up was 18,2 ± 13,5 months. The fracture was arthroscopically reduced and percutaneously fixed with a screw osteosynthesis (Group 1), reduced via a dorsal approach without (Group 2) or with an autologous bone graft (Group 3). Subjective IKDC score was 79,15 ± 6,07. Functional Rasmussen scores ranged from 27 to 30 (mean 28 ± 2.71). Radiological Rasmussen scores ranged from 16 to 18 points (mean 16.75 ± 1.33). According to IKDC score (p = 0.60), functional Rasmussen score (p = 0.829) and radiological Rasmussen score (p = 0.679) no significant discrepancy between the groups were seen. There was no failure of the ACL graft recorded. Conclusions: Posterolateral tibial plateau fractures in combination with an ACL-tear, can cause persistent instability and increase rotational instability. Indication for treatment of these fractures is still under debate. From the biomechanical aspect the lack of more than 50% of the posterior horn of the lateral meniscus and dislocation/depression of more than 2 mm results in an increased rotational instability of the ACL deficient knee. Combined surgical treatment with ACL repair or reconstruction is a safe procedure that results in good, short-term clinical outcome, if our algorithm is followed. In addition this study shows, that majority of posterolateral tibial plateau fractures can be treated arthroscopically. pubtype: Academic Journal doctype: algorithm diagnostic images research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|