Enhanced articular exposure using a lateral patellar ligament approach in Schatzker IV-C tibial plateau fractures: A cadaveric and clinical case series

BackgroundSchatzker IV-C tibial plateau fractures pose a significant challenge for adequate visualization and reduction of the lateral articular surface through a solitary posteromedial (PM) approach. This study aimed to evaluate the effectiveness of an adjunctive lateral patellar ligament (LPL) approach in enhancing articular exposure, assessed through cadaveric modeling and a clinical case series.MethodsIn a cadaveric study, eight preserved knee specimens were dissected using a combined PM and LPL approach. The exposed articular area was quantitatively measured using calibrated digital imaging and ImageJ software before and after the LPL approach was established. Clinically, a case series of 10 patients with Schatzker IV-C fractures underwent open reduction and internal fixation via the combined approach between October 2021 and December 2023. Outcome measures included intraoperative exposure, 12-month postoperative Knee Society Score (KSS), and complications.ResultsThe addition of the LPL approach resulted in a 96% increase in the mean exposed articular area (from 8.4 cm² to 16.5 cm²; <i>p</i> < .001) in the cadaveric specimens. All clinical fractures achieved satisfactory reduction and healing. At the 12-month follow-up, the mean KSS was 85.3 (range: 78-88), with no cases of infection, wound complications, or delayed union observed.ConclusionsThe lateral patellar ligament approach significantly improves the surgical exposure of the lateral tibial plateau in Schatzker IV-C fractures when combined with the standard posteromedial approach. This technique facilitates anatomical reduction and meniscal management, contributing to favorable short-term functional outcomes with a low complication rate. It represents a valuable auxiliary option for these complex fractures, particularly in cases involving lateral meniscal impaction or plateau widening.