scholarly journals Comparison of articular exposure through extended lateral approaches to the tibial plateau

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0031
Author(s):  
Jannik Frings ◽  
Matthias Krause ◽  
Hüseyin Isik ◽  
Karl-Heinz Frosch
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Lateral Collateral Ligament ◽  
Joint Surface ◽  
Anatomical Reconstruction ◽  
Anterolateral Approach ◽  
Popliteus Tendon ◽  
Lateral Tibial Plateau ◽  
Lateral Epicondyle

Aims and Objectives: Comminuted lateral tibial plateau fractures pose a challenge to surgeons, resulting in non-anatomical reductions in 70-89% of all cases. Anatomical reconstruction requires the direct visualization of the joint after a fragment reduction, which is impaired using the common anterolateral approach. Although numerous lateral extended approaches are described, there is currently no data on which approach provides better visibility of the posterolateral tibial plateau. The aim of this study was to evaluate, which parts of the tibial plateau can be visualized with the use of the lateral femoral epicondyle osteotomy or the fibula osteotomy? Further, the study investigated wether the combined osteotomy of the femoral footprints of the lateral collateral ligament (LCL) and popliteus tendon (PLT) provide better access to the posterolateral joint surface than the isolated osteotomy of the femoral LCL footprint or the fibula osteotomy? Materials and Methods: Extended lateral (femoral or fibular LCL osteotomy) and posterolateral (additional femoral osteotomy of the PLT tendon) approaches were performed on twelve human cadaver knee joints. After preparing of each surgical approach, the visible joint surface was marked with diathermy. The tibial plateau was disarticulated and the markings were measured digitally with open-source processing software. Differences in mean values were tested with a paired t-test (p < 0.05). Results: The greatest articular exposition was realized by the fibula osteotomy (1011.52 ± 227.05 mm2 [86.64 ± 4.84%] compared to either osteotomy of LCL and PLT (p = 0.036) or LCL alone (p<0.001). The lateral femoral epicondyle osteotomy of the LCL including the PLT (937.45 ± 237.84 mm2 [80.29 ± 8.25 %]) exposed a significantly larger articular surface of the lateral tibial plateau than without the PLT (755.71 ± 183.06 mm2 [64.73 ± 6.51 %], p < 0.001). Conclusion: The fibula osteotomy provides the greatest articular visibility of the lateral tibial plateau compared to the lateral epicondyle osteotomy of the femoral LCL and PLT attachments. This small benefit should be critically balanced against the considerably greater soft tissue damage caused by the fibula osteotomy. The lateral femoral epicondyle osteotomy including the LCL and PLT increases lateral articular visualization without risk to neurovascular or posterolateral soft tissue structures and represents an important extended approach to treat comminuted lateral plateau fractures.

scholarly journals Prediction of Meniscal and Ligamentous Injuries in Lateral Tibial Plateau Fractures Based on Measurements of Lateral Plateau Widening on Multidetector Computed Tomography Scans

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Jan P. Kolb ◽  
Marc Regier ◽  
Eik Vettorazzi ◽  
Norbert Stiel ◽  
Jan P. Petersen ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Multidetector Ct ◽  
Lateral Meniscus ◽  
Case Series ◽  
Lateral Collateral Ligament ◽  
Tibial Plateau Fractures ◽  
Lateral Tibial Plateau ◽  
Plain Radiographs ◽  
Lateral Plateau

Background. The influence of increasing lateral plateau widening on the frequency of meniscal and ligamentous lesions in lateral tibial plateau fractures has been examined in very few studies using plain radiographs. Because the amount of this parameter cannot be measured accurately on plain radiographs, the purpose of this survey was to look for a possible correlation between the extent of lateral plateau widening, as measured on multidetector CT (MDCT) scans, and different soft-tissue injuries determined from magnetic resonance imaging (MRI). Materials and Methods. 55 patients with a lateral tibial plateau fracture were included in this retrospective case series. Patient age averaged 52.6 years (SD = 18.0). The degree of lateral plateau widening was measured on CT images. MRIs were screened for meniscal and ligamentous injuries. Results. We found a significant effect of increasing lateral plateau widening on the incidence of lateral meniscus lesions (P = 0.021), lateral collateral ligament tears (P = 0.047), and the overall quantity of meniscal and ligamentous lesions (P = 0.001). Discussion. MRIs are not widely used as a diagnostic tool in lateral plateau fractures of the tibia. Reasons might be the costs and the fact that it is a time-consuming examination. The results of this study may help to estimate the probability of specific soft-tissue lesions in lateral tibial plateau fractures based on measurements of lateral plateau widening on MDCT scans, and they may guide the decision for additional MRI and/or arthroscopically assisted repair.

Improved Visualization by Central Subluxation of the Lateral Meniscus in Comminuted Lateral Tibial Plateau Fractures

2020 ◽  
Author(s):  
Matthias Krause ◽  
Dario Guttowski ◽  
Klaus Püschel ◽  
Jan Philipp Kolb ◽  
Maximilian Hartel ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Articular Surface ◽  
Lateral Meniscus ◽  
Lateral Approach ◽  
Tibial Plateau Fractures ◽  
Surgical Reconstruction ◽  
Joint Surface ◽  
Anatomical Reconstruction ◽  
Lateral Plateau ◽  
Extended Lateral Approach

AbstractThe goal of surgical reconstruction of comminuted tibial plateau fractures is an anatomical reconstruction and stable fixation of the articular surface. This can be difficult due to poor visualization of the posterolateral and central segments of the articular surface of the proximal tibia. To improve visualization, the lateral approach can be extended with an osteotomy of the femoral epicondyle. In most cases, use of the extended lateral approach allows the whole lateral plateau to be visualized. Nevertheless, in some cases, an osteotomy alone is not enough to expose the entire fracture, especially the central segments of the tibial plateau. For these specific cases, we developed an additional technical trick that significantly improves articular visualization; the lateral meniscocapsular fibers are dissected allowing for central subluxation of the lateral meniscus, while leaving the anterior and posterior roots intact. With central subluxation of the lateral meniscus in comminuted tibial plateau fractures, the joint surface can be completely visualized, allowing an anatomical reduction even in highly complex fractures.

scholarly journals High-energy tibial plateau fractures treated with Ilizarov fixator

2019 ◽  
Vol 147 (7-8) ◽  
pp. 427-431
Author(s):  
Slavko Tomic ◽  
Andreja Baljozovic ◽  
Danilo Jeremic
Keyword(s):  
Soft Tissue ◽  
Knee Society Score ◽  
Tibial Plateau ◽  
Articular Surface ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Anatomical Reconstruction ◽  
Significant Group ◽  
Ilizarov Fixator

Introduction/Objective. Tibial plateau fractures constitute a significant group of injuries to a major weight-bearing joint. High-energy fractures are difficult to treat, as they entail articular depression, condylar displacement, dissociation of comminuted metaphysis, and closed degloving injuries. The principles of the treatment are anatomical reconstruction of the articular surface, restoration of the anatomical axis, fixation spanning the metaphyseal comminution, and further minimization of soft tissue injury. The aim of this study is to evaluate the clinical outcome of using Ilizarov external fixator in the treatment of high-energy Schatzker IV, V, and VI tibial plateau fractures. Methods. This retrospective study was conducted from 2013?2016 on 35 patients (36 fractures) with high-energy tibial plateau fractures classified as Schatzker type IV, V, and VI. The mechanisms of injury were road traffic accident, fall from a height and direct trauma. The fractures were closed in 26 cases and open in 10 cases. All patients were treated with ligamentotaxis and percutaneous fixation using Ilizarov fixator. Functional outcome was determined using the Knee Society Score. Results. The mean follow-up period was 20 months. All fractures healed in an average time of 14 weeks. The range of knee flexion after one-year follow-up averaged at 100?. Average Knee Society Score in our study was 77. Conclusion. Ilizarov external fixation is a safe and efficient treatment modality for high-energy tibial plateau fractures. It allows reconstruction of the articular surface, stable fixation, early rehabilitation, and care of soft tissue injuries.

Extended Anterolateral Approach for Complex Lateral Tibial Plateau Fractures

2017 ◽  
Vol 30 (03) ◽  
pp. 204-211 ◽  
Author(s):  
Joseph Schatzker ◽  
Marcello Castiglia ◽  
Vincenzo Giordano ◽  
Fabricio Fogagnolo ◽  
James Stannard ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Anterolateral Approach ◽  
Lateral Tibial Plateau

The Segond Fracture Is an Avulsion of the Anterolateral Complex

2017 ◽  
Vol 45 (10) ◽  
pp. 2247-2252 ◽  
Author(s):  
Humza Shaikh ◽  
Elmar Herbst ◽  
Ata Amir Rahnemai-Azar ◽  
Marcio Bottene Villa Albers ◽  
Jan-Hendrik Naendrup ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Anterolateral Ligament ◽  
Fibular Head ◽  
Lateral Tibial Plateau ◽  
Segond Fracture ◽  
Posterior Aspect ◽  
Tibial Insertion ◽  
Anterolateral Capsule ◽  
The Mean

Background: The Segond fracture was classically described as an avulsion fracture of the anterolateral capsule of the knee. Recently, some authors have attributed its pathogenesis to the “anterolateral ligament” (ALL). Biomechanical studies that have attempted to reproduce this fracture in vitro have reported conflicting findings. Purpose: To determine the anatomic characteristics of the Segond fracture on plain radiographs and magnetic resonance imaging (MRI), to compare this location with the location of the ALL described in prior radiographic and anatomic publications, and to determine the fracture’s attachments to the soft tissue anterolateral structures of the knee. Study Design: Case series; Level of evidence, 4. Methods: A total of 36 anterior cruciate ligament–injured patients with Segond fractures (33 male, 3 female; mean age, 23.2 ± 8.4 years) were enrolled. MRI scans were reviewed to determine the anatomic characteristics of the Segond fracture, including the following: proximal-distal (PD) length, anterior-posterior (AP) width, medial-lateral (ML) width, PD distance to the lateral tibial plateau, AP distance to the Gerdy tubercle (GT), and AP distance from the GT to the posterior aspect of the fibular head. The attachment of the anterolateral structures to the Segond fragment was then categorized as the iliotibial band (ITB) or anterolateral capsule. Interrater reliability of the measurements was determined by calculating the Spearman rank correlation coefficient. MEDLINE, Web of Science, and the Cochrane Library were searched from inception to May 2016 for the following keywords: (1) “Segond fracture,” (2) “anterolateral ligament,” (3) “knee avulsion,” (4) “lateral tibia avulsion,” and (5) “tibial plateau avulsion.” All studies describing the anatomic location of the Segond fracture and the ALL were included in the systematic review. Results: On plain radiographs, the mean distance of the midpoint of the fracture to the lateral tibial plateau was 4.6 ± 2.2 mm. The avulsed fracture had a mean PD length of 9.2 ± 2.5 mm and a mean ML width of 2.4 ± 1.4 mm. On MRI, the mean distance of the proximal fracture to the tibial plateau was 3.4 ± 1.6 mm. The mean PD length was 8.7 ± 2.2 mm, while the mean AP width was 11.1 ± 2.2 mm. The mean distance between the GT and the center of the fracture was 26.9 ± 3.3 mm, while the mean distance between the GT and the posterior fibular head was 53.9 ± 4.4 mm. The mean distance of the midpoint of the fracture to the tibial plateau was 7.8 ± 2.7 mm, while the center of the fracture was 49.9% of the distance between the GT and the posterior aspect of the fibular head. Analysis of soft tissue structures attached to the fragment revealed that the ITB attached in 34 of 36 patients and the capsule attached in 34 of 36 patients. One patient had only the capsule attached, another had only the ITB attached, and the last showed neither clearly attached. A literature review of 20 included studies revealed no difference between the previously described Segond fracture location and the tibial insertion of the ALL. Conclusion: The results of this study confirmed that while the Segond fracture occurs at the location of the tibial insertion of the ALL, as reported in the literature, MRI was unable to identify any distinct ligamentous attachment. MRI analysis revealed that soft tissue attachments to the Segond fracture were the posterior fibers of the ITB and the lateral capsule in 94% of patients.

scholarly journals Radiological Outcome Measures Indicate Advantages of Precontoured Locking Compression Plates in Elderly Patients With Split-Depression Fractures to the Lateral Tibial Plateau (AO41B3)

2021 ◽  
Vol 12 ◽  
pp. 215145932110439
Author(s):  
Wolf C. Prall ◽  
Thomas Kusmenkov ◽  
Maximilian Rieger ◽  
Florian Haasters ◽  
Hermann O. Mayr ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Outcome Measures ◽  
Tibial Plateau ◽  
Young Patients ◽  
Joint Surface ◽  
Secondary Outcome ◽  
Radiological Outcome ◽  
Lateral Tibial Plateau ◽  
Significant Deterioration ◽  
Locking Compression Plates

Background Split-depression fractures to the lateral tibial plateau (AO41B3) often feature severe joint surface destructions. Precontoured locking compression plates (LCPs) are designed for optimum support of the reduced joint surface and have especially been emphasized in reduced bone quality. A lack of evidence still inhibits their broad utilization in elderly patients. Thus, aim of the present study was to investigate the implant-specific radiological outcomes of AO41B3-fractures in young versus elderly patients. Methods The hospital’s database was screened for isolated AO41B3-factures, open reduction and internal fixation (ORIF), and radiological follow-up ≥12 months. CT-scans, radiographs, and patients’ records were analyzed. Patients were attributed as young (18–49) or elderly (≥50 years). Additional subgrouping was carried out into precontoured LCP and conventional implants. The Rasmussen Radiological Score (RRS) after 12 months was set as primary outcome parameter. The RRS postoperatively and the medial proximal tibial angle (MPTA) postoperatively and after 12 months were secondary outcome parameters. Results Fifty nine consecutive patients were included (26 young, 38.2 ± 7.8 years; 33 elderly, 61.3 ± 9.4 years). There were no significant differences regarding mean size and depression depth of the lateral joint surface fragments. Prior to implant-specific subgrouping, the radiological outcome measures revealed no significant differences between young (RRS = 7.7 ± 1.7; MPTA = 90.3 ± 2.3°) and elderly (RRS = 7.2 ± 1.7; MPTA = 90.5 ± 3.3°). After implant-specific subgrouping, the radiological outcome revealed significantly impaired results in young patients with conventional implants (RRS(C) = 6.9 ± 1.6, RRS(LCP) = 8.5 ± 1.5, P = .015; MPTA(C) = 91.5 ± 1.9°, MPTA(LCP) = 89.1 ± 2.1°, P = .01). The effect was even more pronounced in elderly patients, with highly significant deterioration of the radiological outcome measures for conventional implants compared to precontoured LCP (RRS(C) = 5.7 ± 1.6, RRS(LCP) = 8.2 ± .8, P < .001; MPTA(C) = 92.6 ± 4.2°, MPTA(LCP) = 89.2 ± 1.4°, P = .002). Conclusion Utilizing precontoured LCP in the treatment of AO41B3-fractures is associated with improved radiological outcomes. This effect is significant in young but even more pronounced in elderly patients. Consequently, precontoured LCP should closely be considered in any AO41B3-fracture, but especially in elderly patients.

scholarly journals Is there difference and correlation between medial and lateral tibial plateau coronal obliquity in native knee? A radiographic study

2021 ◽  
Vol 28 ◽  
pp. 221049172110569
Author(s):  
Thomas Ka Chun Leung ◽  
Will Wai Hong Lau ◽  
Wing Chiu Fung ◽  
Vincent Wai Kwan Chan ◽  
Amy Cheung ◽  
...  
Keyword(s):  
Knee Joint ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Young Patients ◽  
Joint Line ◽  
Significant Implication ◽  
Lateral Tibial Plateau ◽  
Radiographic Measurements ◽  
Significant Difference ◽  
Joint Line Obliquity

Background/Purpose Knee joint line is commonly defined as a tangent to medial and lateral tibial plateaus in various radiographic measurements. We aim to investigate radiographic differences between medial and lateral knee joint line coronal obliquity. It has significant implication on radiographic analysis following unicompartmental knee arthroplasty. Methods We analysed the knee radiographs of 48 young patients (mean age 25.1 + /-5.6 years) with 50 anterior cruciate ligament-deficient knees. Medial and lateral tibial plateau coronal obliquity were defined as angles between femoral knee joint line and the tangent to articular surface of each tibial plateau. Mediolateral differences and linear correlation were analysed. Results Significant difference was found between medial (mean = -1.5, SD = 2.4 degrees) and lateral obliquity (mean =  + 0.6, SD = 3.0 degrees) ( p < 0.001). The mean mediolateral difference was 3.1 degrees (SD = 2.8, range 0–11.8 degrees), without significant correlation (r = 0.085, p = 0.56). Conclusion Mediolateral differences exist in knee joint line obliquity. Each compartment should be considered separately when measuring knee joint line obliquity.

scholarly journals PEDIATRIC ELBOW COLLATERAL AND ANNULAR LIGAMENT ANATOMY: A CT-BASED CADAVERIC STUDY

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0026
Author(s):  
Tyler J. Stavinoha ◽  
Peter C. Cannamela ◽  
Theodore J. Ganley ◽  
Kevin G. Shea
Keyword(s):  
Sports Medicine ◽  
Articular Surface ◽  
Ulnar Collateral Ligament ◽  
Longitudinal Axis ◽  
Joint Surface ◽  
Annular Ligament ◽  
Collateral Ligament ◽  
Reconstructive Procedures ◽  
Lateral Epicondyle ◽  
The Sublime

Background: The medial and lateral ligamentous complexes of the elbow provide static restraint to the elbow and serve as important components of posteromedial and posterolateral rotatory instability. Many collateral ligament and medial epicondylar injuries require surgical repair in those with open physes. Little is known about the anatomy of the pediatric elbow and the relationship between these ligaments and physes. Purpose: To evaluate the anterior bundle of the medial collateral ligament complex, lateral ulnar collateral ligament, annular ligament, and relationships to the joint surfaces and physes. Methods: Two cadaveric elbows from a 3 year-old donor were dissected. Collateral and annular ligaments were isolated and left intact at their osseous attachment. Pins were placed at the origins and insertions and CT scans were used to establish precise anatomic relationships. All dissections and measurements were performed by a single orthopedic surgeon with specialization in pediatric sports medicine. Results: The MUCL origin was a mean 4.10 mm distal and anterior to the medial epicondyle, 10.09 mm from the distal humeral articular surface, and 9.01 mm distal to the medial physis. The distal insertion of the MUCL spanned a mean 3.09 mm and was posterior and medial to the sublime tubercle. In the longitudinal axis, the MUCL insertion footprint spanned the tubercle. The origin was a mean 1.20 mm proximal to the sublime tubercle and the distal extent averaged 2.53 mm distal to the tubercle. The center of the MUCL insertional footprint was 0.38 mm distal to the tubercle. The center of the MUCL was 3.87 mm from the olecranon articular surface. The annular ligament had consistent medial and lateral attachments to the ulna. Distance from the annular ligament attachments to the tip of the coronoid averaged 4.6 mm (4.46 & 4.74 lateral and medial for left; 4.80 & 5.27 lateral and medial for right). The LUCL origin was distal and anterior to the lateral epicondyle. It was 3.43 mm from the lateral epicondyle, 7.51 mm from the articular surface and 0.74 mm distal to the physis. Conclusions: This study is the first to describe anatomy of the elbow collateral and annular ligaments in pediatric cadaveric specimens, through a reliable, CT-based identification method. Knowledge of the precise ligamentous attachments and relationships to the physis and to the joint surface is important for reconstructive procedures. A better understanding of these relationships may assist with surgical planning that preserves adjacent physeal growth regions.

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