Clinical outcomes following open reduction and internal fixation without primary cruciate ligament reconstruction or avulsion fixation for Schatzker types IV-VI tibial plateau fractures: a retrospective cohort study

BACKGROUND: Schatzker types IV-VI tibial plateau fractures (TPFs) are frequently complicated by soft tissue injuries. This study aimed to evaluate the clinical and functional outcomes of Schatzker types IV-VI TPFs treated with ORIF alone, and to compare outcomes between patients with and without concomitant anterior or posterior cruciate ligament (ACL or PCL) injuries. METHODS: 316 Schatzker types IV-VI TPFs patients with a mean age of 51.5 ± 13.2 years old who underwent open reduction and internal fixation (ORIF) were enrolled. There were 152, 56 and 108 patients with type IV, type V, and type VI fractures. Simultaneous reconstruction was not performed for ACL or PCL mid-substance injuries and the displaced ACL or PCL avulsion fractures were only reduced without additional specific fixation. According to preoperative MRI images and intraoperative explorations, visual analog pain scale (VAS), knee flexion range of motion (ROM), and American Hospital for Special Surgery Knee Joint (HSS) scores in both groups of ACL/PCL mid-substance injuries and avulsion fractures were separately compared to no ACL/PCL injuries group for a comprehensive assessment of the outcomes. Also, we measured KT-1000 side-to-side difference (SSD) to assist in evaluating anteroposterior knee stability. RESULTS: The incidence of ACL or PCL injuries was approximately 23.1% or 15.2%. KT-1000 (SSD was more likely to be abnormal or severe in patients with ACL or PCL avulsion fractures (P < 0.05) preoperatively and obviously improved postoperatively (P < 0.05). For patients with ACL avulsion fractures, knee flexion ROM was significantly lower than that in patients without ACL injuries during the follow-up (t = -2.089, P = 0.040; t = -2.659, P = 0.010; t = -2.169, P = 0.033; t = -2.200, P = 0.031). Still, these patients manifested as significantly low HSS scores at postoperative 3 and 6 months preoperatively (t = -2.561, P = 0.013; t = -2.164, P = 0.034). CONCLUSIONS: For Schatzker types IV-VI TPFs combined with ACL or PCL injuries, ORIF without concurrent ACL or PCL reconstruction and additional fixation of ACL or PCL avulsion fractures is feasible and can achieve satisfactory outcomes.