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Comparative Study
. 2025 Mar 1;39(3):114-119.
doi: 10.1097/BOT.0000000000002938.

The Midline Lateral Parapatellar Arthrotomy: A Safe Alternative Approach for Lateral Tibial Plateau Fractures

Nathan Heineman  1 , Alexander Turner  1 , Mingyuan Cheng  2 , Ishvinder Grewal  1 , Drew Sanders  1 , Ashoke Sathy  1
Affiliations
Comparative Study

The Midline Lateral Parapatellar Arthrotomy: A Safe Alternative Approach for Lateral Tibial Plateau Fractures

Nathan Heineman et al. J Orthop Trauma. .

Abstract

Objectives: The midline lateral parapatellar (LP) approach has been shown in a cadaveric study to provide superior articular exposure compared with the anterolateral approach (AL). The purpose of this study was to report on outcomes and complications with the LP approach.

Design: Retrospective comparative cohort study and prospective cohort.

Setting: Academic Level-I trauma center.

Patient selection criteria: Adult patients with minimum 3 months follow-up who underwent open reduction internal fixation of an acute, isolated lateral tibial plateau fracture (OTA/AO 41-B1, 41-B2, 41-B3) through an LP arthrotomy or AL submeniscal arthrotomy between 2010 and 2019.

Outcome measures and comparisons: Retrospective cohort evaluated using postoperative complications including infection, delayed wound healing, and reoperation rate. Prospective cohort evaluated using Short Musculoskeletal Function Assessment, knee range of motion, and complications.

Results: A total of 81 patients were studied. The mean age for the LP cohort was 41.5 years (19-79) and 18 of 32 (56.3%) patients were men. The mean age for the AL cohort was 42.8 years (18-71) and 29 of 49 (59.2%) patients were men. The mean age for patients in the prospective study was 31.4 years (19-59) and 9 of 14 (64.3%) patients were men. Mean follow-up was 9.3 months and 20.3 months for the retrospective and prospective cohorts, respectively. There was no significant difference in complication or reoperation rate ( P > 0.39). For the prospective cohort of 14 patients, mean range of motion was 130 degrees. Mean Short Musculoskeletal Function Assessment dysfunction index was 9.0 and mean bother index was 11.1.

Conclusions: The LP approach resulted in comparable clinical and functional outcomes with those reported with the anterolateral approach. It is a safe alternative and may be of most benefit when treating comminuted lateral tibial plateau fractures.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

The authors report no conflict of interest.

References

    1. Meinberg EG, Agel J, Roberts CS, et al. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32(suppl 1):S1–S170.
    1. Barei DP, Nork SE, Mills WJ, et al. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma. 2004;18:649–657.
    1. Georgiadis GM. Combined anterior and posterior approaches for complex tibial plateau fractures. J Bone Joint Surg Br. 1994;76:285–289.
    1. Kugelman D, Qatu A, Haglin J, et al. Impact of psychiatric illness on outcomes after operatively managed Tibial Plateau Fractures (OTA-41). J Orthop Trauma. 2018;32:e221–e225.
    1. Kugelman DN, Qatu AM, Strauss EJ, et al. Knee stiffness after Tibial Plateau Fractures: predictors and outcomes (OTA-41). J Orthop Trauma. 2018;32:e421–e427.

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