Knee Stiffness After Tibial Plateau Fractures: Predictors and Outcomes (OTA-41)

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Objectives:What patient characteristics and injury factors predict decreased knee range of motion (ROM) after operative management of tibial plateau fractures?Design:Prospective cohort study.Setting:Academic medical center.Patients:Over 11 years, tibial plateau fractures at a single academic institution were prospectively followed. A total of 266 patients were included in this study.Intervention:Surgical repair of tibial plateau fractures and secondary interventions due to arthrofibrosis.Main outcome measure:Clinical outcomes were evaluated using the Short Musculoskeletal Function Assessment and ROM at 3-month, 6-month, and long-term follow-up. Secondary outcomes were considered as the need for a subsequent procedure due to arthrofibrosis.Results:At 3-month follow-up, the mean ROM was 113 degrees. By long-term follow-up (mean = 17 months), the mean ROM improved to 125 degrees. Independent predictors of decreased knee ROM were the following: at 3-month follow-up, open fractures (P = 0.047), application of a knee-spanning external fixator (P = 0.026), orthopaedic polytrauma (P = 0.003), and tibial spine involvement (P = 0.043); and at long-term follow-up, nonwhite ethnicity (P = 0.003), increasing age (P = 0.003), and a deep infection (P = 0.002). Ten patients (3.7%) required a secondary procedure for arthrofibrosis. There was a significant improvement in the knee ROM (P < 0.001) and functional outcomes (P = 0.004) following the intervention.Conclusions:At long-term follow-up, independent predictors of decreased knee ROM were nonwhite ethnicity, increasing age, and sustaining a postoperative complication of a deep infection. Secondary interventions were reliable treatments for arthrofibrosis.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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