Arthroscopic bone grafting for Schatzker III tibial plateau fractures: a retrospective comparative study

Abstract

This study aims to compare the clinical efficacy of arthroscopically assisted treatment versus traditional open reduction for Schatzker type III posterolateral tibial plateau collapse fractures. We retrospectively analyzed clinical data from 40 patients with Schatzker type III fractures (lateral plateau collapse) treated at our hospital between October 2020 and March 2024. Patients were divided into two groups: the arthroscopy group (n = 19) and the open incision group (n = 21). General patient information, hospitalization costs, length of stay, and wound length were collected. All patients were followed for one year postoperatively, with knee function assessed using the Lysholm score. Categorical data were analyzed using the chi-square test, and continuous variables using independent sample t-tests. A p-value < 0.05 was considered statistically significant. There were no significant differences in baseline characteristics between the two groups. The arthroscopy group had significantly shorter operation times and postoperative hospital stays compared to the open incision group (p < 0.05). Additionally, surgical costs were significantly lower in the arthroscopy group (p < 0.05). At 3 months postoperatively, the arthroscopy group demonstrated significantly higher Lysholm scores compared to the open incision group. However, there was no significant difference in Lysholm scores between the two groups at the 6 months and 1-year follow-up (p > 0.05). Compared to traditional open reduction and internal fixation, arthroscopic treatment of Schatzker type III posterolateral tibial plateau collapse fractures offers several advantages, including shorter operative time, lower cost, fewer incision-related complications, no need for secondary removal of internal fixation, faster postoperative functional recovery, and minimally invasive, cosmetically favorable incisions.

Keywords: Knee arthroscopy; Posterolateral collapse; Schatzker III type; Tibial plateau fracture.

Fig. 1

(a) The lateral X-ray view, with the red arrow indicating the collapse of the tibial plateau. The arrow in (b) highlights the collapse of the lateral plateau fracture.

Fig. 2

(a), (b) and (c) Present findings from CT three-dimensional reconstruction. The red arrow marks the collapse of the tibial plateau. Intra-articular fractures require further CT three-dimensional reconstruction to clarify the fracture type and guide treatment planning.

Fig. 3

(a) Shows intraoperative arthroscopic findings, where the lateral platform has collapsed significantly, forming a step-off with the surrounding area. (b) Shows the Kirschner wire used to locate the collapsed fracture under the guidance of the locator.

Fig. 4

(a) Presents an intraoperative arthroscopic view after the collapsed lateral platform has been lifted, showing the restored tibial plateau height. (b) and (c) Show the postoperative appearance, with the fracture lifted along the Kirschner wire. The Kirschner wires are inserted one by one, the skin is cut along the wires, and a push rod is used to elevate the collapsed tibial platform.

Fig. 5

(a) and (b) show the completion of the procedure after artificial bone strips are inserted, and the wound is sutured. The technique is minimally invasive and aesthetically pleasing.

Fig. 6

Postoperative CT and X-ray reexaminations (a–d) show that the collapsed fracture surface has fully healed with good results.

Fig. 7

X-rays 6 months after surgery.