Clinical and radiological outcomes following arthroscopic-assisted management of tibial plateau fractures: a systematic review

PURPOSE: To carry out a systematic review of the literature on arthroscopic-assisted management (all types) of tibial plateau fractures to gain a more comprehensive understanding of clinical outcomes with this surgical technique, specifically to determine whether this may be a viable technique for the management of tibial plateau fractures. METHODS: MEDLINE, Cochrane, and EMBASE databases were searched until July 2013 using combinations of the search terms: tibial plateau, fractures, and arthroscopically/arthroscopic/arthroscopy/percutaneous/minimally invasive. Inclusion criteria were observational study, patients with tibial plateau fractures, and clinical and radiological outcomes assessed using Rasmussen scoring system. The outcome measures of interest were clinical and radiological Rasmussen scores and the prevalence of secondary osteoarthritis. RESULTS: A total of 12 studies, 5 prospective and 7 retrospective, involving 353 patients were included in the review. The majority of patients in most studies had Schatzker type I–III fractures. The graft material used varied between studies. The length of the follow-up was typically between 34 and 38 months. Mean clinical Rasmussen scores ranged from 25.5 to 28.4. In each study, the majority (≥80 %) of patients had excellent/good clinical Rasmussen scores. In each study, the majority (≥63 %) of patients had excellent/good radiological Rasmussen scores. The proportion of patients who experienced secondary osteoarthritis was variable, ranging from 0 to 47.6 %. CONCLUSIONS: The results of this systematic review indicate that arthroscopic-assisted management of tibial plateau fractures can be effective. Surgeons should consider using this approach when treating patients with tibial plateau fractures. LEVEL OF EVIDENCE: III.