Abstract
Meniscus tear coexisting with tibial plateau fractures may be found in 2–49% of cases. Literature accepts that torn meniscus can be retracted towards the center to improve visualization of the peripheral plateau which is ordinarily concealed by the overlying meniscus. We hypothesized that easing in microscope through a coexisting tear may be much less disruptive with little or no adverse effects with respect to either the propagation of tear or its later repair. This strategy improved visualization as well as the extended reach of interventional instrumentation access to otherwise concealed areas of plateau and endoscopic trans-focal access to a vertical limb of fracture split on the anterior cortex of proximal tibia without any impact on the stability of repaired meniscus. The experience in a series of six cases is shared.
Similar content being viewed by others
References
Harris, N. L., Purnell, M. L., Pevny, T., & Larson, A. I. (2007). Arthroscopic management of tibial plateau fractures in skiing. Techn Knee Surg, 6(1), 9–16.
Perez, C. L. (1997). Arthroscopic management of tibial plateau fractures: special techniques. Arthroscopy, 13, 265–267.
Kim, Jong-Min., Bin, Seong-II., & Kim, Eugene. (2009). Inframeniscal portal for horizontal tears of the meniscus. Arthrosc J Arthrosc Relat Surg, 25(3), 269–273.
Holzach, P., Matter, P., & Minter, J. (1941). Arthroscopically assisted treatment of lateral tibial plateau fractures in skiers: use of a cannulated reduction system. J Orthop Trauma, 8, 273–281.
Vangsness, C. T., GhaderiB, Hohl M., & Moore, T. M. (1994). Arthroscopy of meniscal injuries with tibial plateau fractures. J Bone Joint Surg Br, 76, 488–90.
Mills, William J., & Nork, Sean E. (2002). Open reduction and internal fixation of high-energy tibial plateau fractures. Orthop Clin N Am, 33(1), 177.
Chen, Dongyang, Li, Qiangqiang, Sun, Ye., Qin, Jianghui, Yao, Yao, & Jiang, Qing. (2017). Arthroscopic management for the unstable inferior leaf of the lateral meniscus anterior horn and associated cysts through a direct inframeniscal portal: a retrospective study. BioMed Res Int, 2017, 9264907. https://doi.org/10.1155/2017/9264907
Akira Tsujii, A., Matsuob, Tomohiko, Kinugasac, Kazutaka, Yonetania, Yasukazu, & Hamadaa, Masayuki. (2018). Arthroscopic minimum saucerization and inferior-leaf meniscectomy for a horizontal tear of a complete discoid lateral meniscus: report of two cases. Int J Surg Case Rep, 53, 372–376.
Jo, Chris Hyunchul, Yoon, Kang Sup, Lee, Ji Ho., Kang, Seung Baik, Lee, Jae Hyup, Han, Hyuk Soo, Rhee, Seung Hwan, & Lee, Myung Chul. (2009). Undermeniscal portal: an alternative portal for an easy access to the medial and lateral menisci. Knee Surg Sports Traumatol Arthrosc., 17, 1344–1346.
Zhou, Zhiyou, Xiao, Lei, Hea, Chongru, Zhang, Yongjin, Xuea, Chenchen, Qiao, Suchi, Zhang, Guobin, & Wanga, Zimin. (2019). Application of assisted portal under anterior horn of lateral meniscus for the treatment of discoid meniscus injury. Knee., 26, 1125–1135.
Thompson, W. O., Thaete, F. L., & Fu, F. H. (1991). Tibial meniscal dynamics using three dimensional reconstruction of magnetic resonance images. Am J Sports Med, 19, 210–216.
Hartigan, David E., McCarthy, Mark A., Krych, Aaron J., & Levy, Bruce A. (2015). Arthroscopic-assisted reduction and percutaneous fixation of tibial plateau fractures. Arthrosc Tech, 4(1), 51–55.
Laprade, Robert F., Arendt, Elizabeth A., Getgood, Alan, & Faucett, Scott C. (2017). The Menisci: a comprehensive review of their anatomy, biomechanical function and surgical treatment. New York: Springer.
Bloecker, K., Guermazi, A., Wirth, W., Benichou, O., Kwoh, C. K., Hunter, D. J., Englund, M., Resch, H., & Eckstein, F. (2013). Tibial coverage, meniscus position, size and damage in knees discordant for joint space narrowing—data from the Osteoarthritis Initiative. Osteoarthr Cartil, 21(3), 419–427.
Funding
No Funding has been received for this study.
Author information
Authors and Affiliations
Contributions
All authors have contributed to the study design, collection and interpretation of data, literature search, preparation of manuscript and proof reading.
Corresponding author
Ethics declarations
Conflict of interest
Authors declare no conflict of interest.
Ethical approval
Study is about the update of a technique of ARIF which is an accepted surgical procedure. There are no ethical implications.
Informed consent
Informed Consents have been obtained from Participants.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Supplementary file1 (MPG 34862 KB)
Supplementary file2 (AVI 75726 KB)
Supplementary file3 (MPG 27366 KB)
Supplementary file4 (MPG 21094 KB)
Supplementary file5 (MPG 43054 KB)
Supplementary file6 (MPG 30284 KB)
Rights and permissions
About this article
Cite this article
Manocha, R.K., Vaish, A. Arthroscopic Assisted Reduction and Internal Fixation of Tibial Plateau Fractures by Viewing and Instrumentation Access Through Coexisting Meniscus Tear: Case Series. JOIO 56, 1613–1624 (2022). https://doi.org/10.1007/s43465-022-00703-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43465-022-00703-7