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ObjectivesTo estimate the risk of clinically diagnosed knee osteoarthritis (OA) after different types of knee injuries in young adults.MethodsIn a longitudinal cohort study based on population-based healthcare data from Skåne, Sweden, we included all persons aged 25–34 years in 1998–2007 (n=149 288) with and without diagnoses of knee injuries according to International Classification of Diseases (ICD)-10. We estimated the HR of future diagnosed knee OA in injured and uninjured persons using Cox regression, adjusted for potential confounders. We also explored the impact of type of injury (contusion, fracture, dislocation, meniscal tear, cartilage tear/other injury, collateral ligament tear, cruciate ligament tear and injury to multiple structures) on diagnosed knee OA risk.ResultsWe identified 5247 persons (mean (SD) age 29.4 (2.9) years, 67% men) with a knee injury and 142 825 persons (mean (SD) age 30.2 (3.0) years, 45% men) without. We found an adjusted HR of 5.7 (95% CI 5.0 to 6.6) for diagnosed knee OA in injured compared with uninjured persons during the first 11 years of follow-up and 3.4 (95% CI 2.9 to 4.0) during the following 8 years. The corresponding risk difference (RD) after 19 years of follow-up was 8.1% (95% CI 6.7% to 9.4%). Cruciate ligament injury, meniscal tear and fracture of the tibia plateau/patella were associated with greatest increase in risk (RD of 19.6% (95% CI 13.2% to 25.9%), 10.5% (95% CI 6.4% to 14.7%) and 6.6% (95% CI 1.1% to 12.2%), respectively).ConclusionIn young adults, knee injury increases the risk of future diagnosed knee OA about sixfold with highest risks found after cruciate ligament injury, meniscal tear and intra-articular fracture.

Purpose Tibial plateau fractures (TPFs) may lead to posttraumatic osteoarthritis and increase the risk for total knee arthroplasty (TKA). The aim of this systematic review was to analyse the conversion rate to TKA after TPF treatment. Methods A systematic search for studies reviewing the conversion rate to TKA after TPF treatment was conducted. The studies were screened and assessed by two independent observers. The conversion rate was analysed overall and for selected subgroups, including different follow-up times, treatment methods, and study sizes. Results A total of forty-two eligible studies including 52,577 patients were included in this systematic review. The overall conversion rate of treated TPF to TKA in all studies was 5.1%. Thirty-eight of the forty-two included studies indicated a conversion rate under 10%. Four studies reported a higher percentage, namely, 10.8%, 10.9%, 15.5%, and 21.9%. Risk factors for TKA following TPF treatment were female sex, age, and low surgeon and hospital volume. The conversion rate to TKA is particularly high in the first 5 years after fracture. Conclusion Based on the studies, it can be assumed that the conversion rate to TKA is approximately 5%. The risk for TKA is manageable in clinical practice. Prospero registration number CRD42023385311. Level of evidence IV.

Purpose The impact of posterolateral tibial plateau impaction fractures (TPIF) on posttraumatic knee stability in the setting of primary anterior cruciate ligament (ACL) tear is unknown. The main objective was to determine whether increased bone loss of the posterolateral tibial plateau is associated with residual rotational instability and impaired functional outcome after ACL reconstruction. Methods A cohort was identified in a prospective enrolled study of patients suffering acute ACL injury who underwent preoperative standard radiographic diagnostics and clinical evaluation. Patients were included when scheduled for isolated single-bundle hamstring autograft ACL reconstruction. Exclusion criteria were concurrent anterolateral complex (ALC) reconstruction (anterolateral tenodesis), previous surgery or symptoms in the affected knee, partial ACL tear, multi-ligament injury with an indication for additional surgical intervention, and extensive cartilage wear. On MRI, bony (TPIF, tibial plateau, and femoral condyle morphology) and ligament status (ALC, concomitant collateral ligament, and meniscus injuries) were assessed by a musculoskeletal radiologist. Clinical evaluation consisted of KT-1000, pivot-shift, and Lachman testing, as well as Tegner activity and IKDC scores. Results Fifty-eight patients were included with a minimum follow-up of 12 months. TPIF was identified in 85% of ACL injuries ( n  = 49). The ALC was found to be injured in 31 of 58 (53.4%) cases. Pearson analysis showed a positive correlation between TPIF and the degree of concomitant ALC injury ( p  < 0.001). Multiple regression analysis revealed an increased association of high-grade TPIF with increased lateral tibial convexity ( p  = 0.010). The high-grade TPIF group showed worse postoperative Tegner scores 12 months postoperatively ( p  = 0.035). Conclusion Higher degrees of TPIFs are suggestive of a combined ACL/ALC injury. Moreover, patients with increased posterolateral tibial plateau bone loss showed lower Tegner activity scores 12 months after ACL reconstruction. Level of evidence III.

BackgroundTraditionally, size of the posterior fragment is considered the most important indicator for fixation in trimalleolar fractures. It remains unclear which factors contribute to worse functional and radiological outcome. This study was designed to determine predictors for the development of posttraumatic osteoarthritis and worse functional outcome in trimalleolar fractures.MethodsThis retrospective cohort study evaluated outcomes of 169 patients with a trimalleolar fracture treated between 1996 and 2013 in a level-1 trauma hospital in the Netherlands after a mean follow-up of 6.3 (range 2.4 to 15.9) years. The average fragment size was 17%. Twenty patients had a posterior fragment smaller than 5% of the intra-articular surface, 119 patients a fragment of 5–25% and 30 patients a posterior fragment larger than 25%. In total, 39 patients (23%) underwent fixation of the posterior fragment.ResultsClinical union was achieved in all 169 patients. The median AOFAS score after follow-up was 93 (interquartile range 76–100) and the median AAOS score was 92 (interquartile range 81–98). A persistent postoperative step-off larger than 1 mm was found in 65 patients (39%) and osteoarthritis was present in 49 patients (30%). Higher age and postoperative step-off > 1 mm were independent, significant risk factors for the development of osteoarthritis. Osteoarthritis and BMI were independent, significant risk factors for worse functional outcome.ConclusionIt is advisable to correct intra-articular step-off of intraarticular posterior malleolar fragments to reduce the risk of developing osteoarthritis and, consequently, the risk of worse functional outcome after long-term follow-up.Level of evidenceLevel IIB.

IntroductionOnly few and inconsistent data about the impact of articular congruity and tolerable residual intraarticular steps and gaps of the joint surface after tibial plateau fractures exist. Therefore, aim of this study was to investigate the correlation between OTA type B and C tibial plateau fracture outcomes and postoperative articular congruity using computed tomography (CT) data.Materials and methodsFifty-five patients with a mean age of 45.5 ± 12.5 years and treated for 27 type B and 28 C tibial plateau fractures with pre- and postsurgical CT data were included. Primary outcome measure was the correlation of postoperative intraarticular step and gap sizes, articular comminution area, the postoperative medial proximal tibial angle (MPTA), and the Lysholm and IKDC score. Receiver-operating characteristic (ROC) curves were used to determine threshold values for step and gap heights according to the following outcome scores: IKDC > 70; Lysholm > 80. Secondary outcome measures were the correlation of fracture severity, the number of complications and surgical revisions and the outcome scores, as well as the Tegner activity score before injury and at final follow-up.ResultsAfter a mean follow-up of 42.4 ± 18.9 months, the mean Lysholm score was 80.7 ± 13.3, and the mean IKDC score was 62.7 ± 17.6. The median Tegner activity score was 5 before the injury and 4 at final follow-up (p < 0.05). The intraarticular step height, gap size, comminution area and MPTA deviation were significantly negatively correlated with the IKDC and Lysholm scores. The cutoff values for step height were 2.6 and 2.9 mm. The gap size threshold was 6.6 mm. In total, an average of 0.5 ± 0.8 (range 0–3) complications occurred, and on average, 0.5 ± 1.1 (range 0–7) surgical revisions had to be performed. The number of complications and surgical revisions also had negative impacts on the outcome. Neither fracture severity nor BMI or patient’s age was significantly correlated with the IKDC or Lysholm score.ConclusionsTibial plateau fractures are severe injuries, which lead to a subsequent reduced level of patient activity. Precise reconstruction of the articular surface with regard to intraarticular step and gap size, residual comminution area and joint angle is decisive for the final outcome. Complications and surgical revisions also worsen it.Level of evidenceIII.

The simultaneous posterolateral tibial plateau fracture (PLTPF) with anterior cruciate ligament (ACL) injury has posed a great challenge to both orthopedic trauma and sports medicine surgeons. This study investigated the biomechanical mechanism of simultaneous PLTPF with ACL injury and demonstrated the consistency with anterolateral rotatory instability (ALRI) of the knee. A healthy male volunteer’s right knee CT and MRI images were imported into Mimics software to reconstruct a three-dimensional geometric model of bone, ligament, meniscus and cartilage. The PLTPF were simulated at posterior half of the lateral tibial plateau (LTP) and lateral meniscus posterior horn (LMPH). Three PLTPF depression angles were set at 5°, 10° and 15°. Finite element analysis (FEA) was conducted to observe the displacement of bone and meniscus, ACL strain and LTP stress at 0°and 30° knee flexion with axial and tibial internal rotation loading, in ACL intact and deficient knee. For ACL intact knee, FEA showed axial loading at 0° knee flexion led to abnormal displacements of lateral femoral condyle and LMPH. At 30° flexion, axial 10Nm tibia internal rotation loading resulted in more LTP anterior displacement and ACL strains. The stress of LTP concentrated abnormally on anterolateral part at 0° flexion and posterolateral LTP at 30° flexion. All above parameters tended to increase with the enlargement of depression area and depression angle. In ACL deficient knee, axial 10Nm tibia internal rotation loading led to even more LTP anterior displacement and LTP articular stress at 30° flexion than ACL intact knee, with a tendency of aggravating with increasing depression area and angle. Simultaneous PLTPF with ACL injury has a common flexion valgus and tibial internal rotation injury mechanism with ALRI and should be treated as a special pattern of ALRI. Clinically, high grade PLTPF associated with ACL injury should be addressed by concomitant PLTPF reduction and ACL reconstruction to fully restore LTP articular congruence and knee stability.

Background Posterior tibial plateau bicondylar fracture combined with anterior cruciate ligament injury, also known as the “Posterior Condylar Triad”, is a regular combination injury. The traditional surgical strategy involves first fixing the posterior condyle in the prone position and then treating the anterior cruciate ligament avulsion injury after the patient turns over. This surgical strategy is cumbersome, requires multiple surgical preparations, prolongs the surgical time, and increases the patient’s risk. Our centre proposed one lateral prone position with three incisions to treat the “Posterior Condylar Triad”. Methods This was a retrospective analysis of the clinical data of 11 “Posterior Condylar Triad” patients who underwent surgical treatment at our centre from February 2017 to August 2020. Using a unified surgical strategy, the patient rotates the limb in a lateral prone position. The posterior condyle fracture of the tibial plateau is treated through a posterior medial incision and posterior lateral Frosch approach. Finally, anterior cruciate ligament avulsion fracture is treated through a small incision on the medial side of the patella. All patients were encouraged to perform functional exercises of the knee joint early after surgery. The postoperative complications (deep vein thrombosis, poor wound healing, deep infection, internal fixation failure and fracture reduction loss) and knee joint function (knee joint range of motion, Lysholm score and SF36 scale) of the patients were recorded 1 year after surgery. Results All patients’ fractures healed smoothly, with an average fracture healing time of 17.0 weeks, ranging from 12 to 22 weeks. There were 2 patients with deep vein thrombosis (DVT) after the operation. One patient experienced wound fat liquefaction, and no patients reported serious complications, such as loss of fracture reduction, failure of internal fixation, or deep infection. One year after surgery, the average range of motion (ROM) of the affected limb’s knee joint was 3.6–120.5°, the average Lysholm score was 86.7, ranging from 61 to 100, and the average SF36 score was 76.96, with a range of 52.45–94.75. Conclusion The “Posterior Condylar Triad” is a serious injury, and our proposed surgical strategy can simplify the surgical process, avoid large-scale changes in patient position during surgery, shorten surgical time, and reduce the risk of surgical anaesthesia, enabling patients to achieve good clinical prognosis.

Background Traumatic brain injury (TBI) has been known to accelerate bone healing. Many cells and molecules have been investigated but the exact mechanism is still unknown. The neuroinflammatory state of TBI has been reported recently. We aimed to investigate the effect of TBI on fracture healing in patients with tibia fractures and assess whether the factors associated with hematoma formation changed more significantly in the laboratory tests in the fractures accompanied with TBI. Methods We retrospectively investigated patients who were surgically treated for tibia fractures and who showed secondary bone healing. Patients with and without TBI were divided for comparative analyses. Radiological parameters were time to callus formation and the largest callus ratio during follow-up. Preoperative levels of complete blood count and chemical battery on admission were measured in all patients. Subgroup division regarding age, gender, open fracture, concomitant fracture and severity of TBI were compared. Results We included 48 patients with a mean age of 44.9 (range, 17–78), of whom 35 patients (72.9%) were male. There were 12 patients with TBI (Group 1) and 36 patients without TBI (Group 2). Group 1 showed shorter time to callus formation ( P  <  0.001), thicker callus ratio ( P  = 0.015), leukocytosis and lymphocytosis ( P  ≤ 0.028), and lower red blood cell counts (RBCs), hemoglobin, and hematocrit (P <  0.001). Aging and severity of TBI were correlated with time to callus formation and callus ratio ( P  ≤ 0.003) while gender, open fracture, and concomitant fracture were unremarkable. Conclusion Tibia fractures with TBI showed accelerated bone healing and superior measurements associated with hematoma formation (lymphocytes, RBCs, hemoglobin, hematocrit). Promoted fracture healing in TBI was correlated with the enhanced proinflammatory state. Level of evidence III, case control study.

Purpose Acute compartment syndrome (ACS) is a severe complication associated with tibial fractures, which can result in irreversible muscle and nerve damage if not promptly identified and treated. Method This study systematically searched PubMed, EMBASE, the Cochrane Library, and Web of Science. Data on demographics, fracture attributes, injury mechanisms, and biomarkers were extracted. Meta-analyses were performed using both fixed- and random-effects models, depending on the degree of heterogeneity. Result A total of 17 studies were included. Younger adult age and older age in pediatric populations were both linked to higher ACS risk, depending on the age group. ale sex was strongly associated with ACS. High-energy traumaand polytrauma were also associated with a heightened risk. Delayed external fixation also showed a protective effect, albeit based on limited evidence. Biomarkers, including elevated monocyte count and creatine kinase-MB levels, were also significant predictors. Conclusion Younger adult age, male sex, high-energy trauma, and polytrauma were identified as critical risk factors for ACS in tibial fractures. Findings emphasize the need for standardized definitions and prospective investigations. Further research addressing pediatric age ranges, fracture location, and biomarker validation is essential to refine risk assessment and optimize early interventions.

Background The incidence of post-traumatic osteoarthritis (OA) following intraarticular knee fractures has been estimated to be relatively high but it varies substantially between different reports. In this study we sought to assess the prevalence of radiographic knee OA secondary to tibial plateau fractures (TPF). The second aim was to report medium- and long-term functional outcomes and investigate whether there were any risk factors associated with these outcomes. Methods We retrospectively reviewed documentation of patients who had TPF between 2001 and 2015. The radiographs, clinical characteristics and patient-reported outcome measures (PROMs) scores were evaluated. Presence of radiographic OA was the primary endpoint. The other endpoints were the relationship between OA and different potential predictors as well as the scores in PROMs. Results The study involved a total of 130 patients including 114 who were radiographically examined at mean follow-up time of 10 years (range 4.6–19.3 years). Radiographic OA was present in 50% of patients (34% in the injured knee and 16% in both knees). Having OA in the contralateral knee increased the odds to develop OA in the index knee (OR = 4.8; 95%CI 1.6–4.1 in the crude model and OR = 6.6; 95%CI 1.8–23.5 in the model adjusted for age, sex, BMI, fracture type and treatment method). The occurrence of OA was associated stronger with medial or bicondylar TPF than with lateral condyle TPF (OR = 2.8; 95%CI 1.2–6.1 in the crude model and OR = 3.4; 95%CI 1.4–8.6 in the adjusted model). The KOOS scores were significantly lower in patients with OA than in those without OA in the index knee in all the KOOS subscales ( p  < 0.007), except for the KOOS Symptoms ( p  = 0.362). The EQ-5D-5L index score was significantly higher in patients without OA in the index knee compared to those with OA ( p  = 0.015). Conclusion Radiographic OA following TPF occurred in 50% of knee joints. The odds for knee OA were highest after medial or bicondylar fractures. Patients with OA in the index knee had lower scores in both condition-specific and generic PROMs than subjects without OA, which indicates that TPF may contribute to the development of both OA disease and illness. Trial registration The trial was registered retrospectively on June 4, 2024 on ClinicalTrials .gov (registration number: NCT06451510).