Retrospective cohort of 131 tibial plateau fractures followed a mean 7.6 years to quantify secondary osteoarthritis incidence. The study identifies which injury and surgical variables — meniscal status, plateau alignment, step-off, ligament injury — drive the degenerative process. The central question: what can a surgeon control to reduce arthritis after plateau fracture?
Half your tibial plateau fracture patients will have radiographic arthritis within a decade — and most of that degeneration is locked in by year 7. The variable you control most is the meniscus: removing it more than doubles arthritis risk.
When you encounter a meniscal tear at plateau fracture surgery, repair it rather than excise it. Most plateau-associated meniscal tears involve the red zone and are amenable to repair. Honkonen's data make meniscectomy essentially indefensible as a routine step.
Counsel patients with ligamentous injuries that 75% will develop arthritis regardless of achieving stability. The original impact likely caused irreversible chondral damage. Step-off magnitude alone should not drive your reduction targets; plateau alignment and meniscal integrity are the variables that actually predict degeneration.
Retrospective cohort of 131 tibial plateau fractures followed a mean 7.6 years to quantify secondary osteoarthritis incidence. The study identifies which injury and surgical variables — meniscal status, plateau alignment, step-off, ligament injury — drive the degenerative process. The central question: what can a surgeon control to reduce arthritis after plateau fracture?
Half your tibial plateau fracture patients will have radiographic arthritis within a decade — and most of that degeneration is locked in by year 7. The variable you control most is the meniscus: removing it more than doubles arthritis risk.
When you encounter a meniscal tear at plateau fracture surgery, repair it rather than excise it. Most plateau-associated meniscal tears involve the red zone and are amenable to repair. Honkonen's data make meniscectomy essentially indefensible as a routine step.
Counsel patients with ligamentous injuries that 75% will develop arthritis regardless of achieving stability. The original impact likely caused irreversible chondral damage. Step-off magnitude alone should not drive your reduction targets; plateau alignment and meniscal integrity are the variables that actually predict degeneration.