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Background <p>Tibial plateau fractures require accurate articular reduction and stable fixation to restore knee function and minimize complications. Arthroscopic-assisted reduction and internal fixation (ARIF) may reduce soft-tissue disruption compared with open reduction and internal fixation (ORIF). To compare clinical outcomes and complication profiles of ARIF versus ORIF for tibial plateau fractures.</p> Methods <p>This retrospective cohort study included adults (≥ 18&#xa0;years) with radiographically confirmed tibial plateau fractures treated surgically between January 2020 and January 2024 at a single center. Patients underwent ORIF (traditional group, n = 65) or ARIF (arthroscopic-assisted group, n = 68). Outcomes included intraoperative blood loss, operative time, incision length, time to ambulation, fracture healing time, wound healing time, knee range of motion (ROM), pain assessed by the Visual Analogue Scale (VAS), Lysholm score categories (excellent/good/fair/poor) with effectiveness rate (excellent + good), and postoperative complications. Level of evidence: III.</p> Results <p>Baseline characteristics were comparable (age: 38.1 ± 4.3 vs 37.9 ± 4.1&#xa0;years, p = 0.748; sex distribution, p = 0.514). Compared with ORIF, ARIF was associated with lower blood loss (200 ± 28 vs 250 ± 50&#xa0;mL; t = 4.779; p &lt; 0.05), shorter operative time (73 ± 12 vs 90 ± 13&#xa0;min; t = 5.263; p &lt; 0.05), and smaller incisions (6.8 ± 1.3 vs 13.8 ± 2.3&#xa0;cm; t = 14.512; p &lt; 0.05). ARIF showed faster recovery, including earlier ambulation (3.2 ± 0.7 vs 5.2 ± 1.6&#xa0;days; t = 6.273; p &lt; 0.05) and shorter fracture healing time (81.3 ± 2.3 vs 87.1 ± 2.8&#xa0;days; t = 8.767; p &lt; 0.05). At 6&#xa0;months, ARIF achieved greater knee flexion (108.0 ± 9.0 vs 97.0 ± 9.6°; t = 4.579; p &lt; 0.05) and lower VAS pain (0.9 ± 0.3 vs 1.4 ± 0.4; t = 5.477; p &lt; 0.05). The Lysholm-based effectiveness rate was higher with ARIF (85.3% vs 66.2%; χ<sup>2</sup> = 5.657; p &lt; 0.05). Traumatic arthritis and wound infection were less frequent after ARIF (4.4% vs 17.0%, χ<sup>2</sup> = 4.275, p &lt; 0.05; 5.9% vs 20.0%, χ<sup>2</sup> = 4.743, p &lt; 0.05).</p> Conclusions <p>In this retrospective cohort, ARIF was associated with improved perioperative efficiency, faster recovery, better short-term functional outcomes, and fewer selected complications compared with ORIF. Prospective, multicenter randomized studies with longer follow-up are warranted to confirm these findings and to further clarify the long-term functional outcomes and complication profiles of ARIF compared with ORIF.</p>

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Comparative effectiveness of arthroscopic-assisted versus open reduction and internal fixation in the treatment of tibial plateau fractures: a retrospective study

  • 期刊论文

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  • 发表日期：

    2026年1月26日

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  • Zhizhong Tian,
  • Ruiping Jia,
  • Xinjun Guo,
  • Likai Zhang,
  • Xiao Yun,
  • Lin Wang

摘要

Background

Tibial plateau fractures require accurate articular reduction and stable fixation to restore knee function and minimize complications. Arthroscopic-assisted reduction and internal fixation (ARIF) may reduce soft-tissue disruption compared with open reduction and internal fixation (ORIF). To compare clinical outcomes and complication profiles of ARIF versus ORIF for tibial plateau fractures.

Methods

This retrospective cohort study included adults (≥ 18 years) with radiographically confirmed tibial plateau fractures treated surgically between January 2020 and January 2024 at a single center. Patients underwent ORIF (traditional group, n = 65) or ARIF (arthroscopic-assisted group, n = 68). Outcomes included intraoperative blood loss, operative time, incision length, time to ambulation, fracture healing time, wound healing time, knee range of motion (ROM), pain assessed by the Visual Analogue Scale (VAS), Lysholm score categories (excellent/good/fair/poor) with effectiveness rate (excellent + good), and postoperative complications. Level of evidence: III.

Results

Baseline characteristics were comparable (age: 38.1 ± 4.3 vs 37.9 ± 4.1 years, p = 0.748; sex distribution, p = 0.514). Compared with ORIF, ARIF was associated with lower blood loss (200 ± 28 vs 250 ± 50 mL; t = 4.779; p < 0.05), shorter operative time (73 ± 12 vs 90 ± 13 min; t = 5.263; p < 0.05), and smaller incisions (6.8 ± 1.3 vs 13.8 ± 2.3 cm; t = 14.512; p < 0.05). ARIF showed faster recovery, including earlier ambulation (3.2 ± 0.7 vs 5.2 ± 1.6 days; t = 6.273; p < 0.05) and shorter fracture healing time (81.3 ± 2.3 vs 87.1 ± 2.8 days; t = 8.767; p < 0.05). At 6 months, ARIF achieved greater knee flexion (108.0 ± 9.0 vs 97.0 ± 9.6°; t = 4.579; p < 0.05) and lower VAS pain (0.9 ± 0.3 vs 1.4 ± 0.4; t = 5.477; p < 0.05). The Lysholm-based effectiveness rate was higher with ARIF (85.3% vs 66.2%; χ2 = 5.657; p < 0.05). Traumatic arthritis and wound infection were less frequent after ARIF (4.4% vs 17.0%, χ2 = 4.275, p < 0.05; 5.9% vs 20.0%, χ2 = 4.743, p < 0.05).

Conclusions

In this retrospective cohort, ARIF was associated with improved perioperative efficiency, faster recovery, better short-term functional outcomes, and fewer selected complications compared with ORIF. Prospective, multicenter randomized studies with longer follow-up are warranted to confirm these findings and to further clarify the long-term functional outcomes and complication profiles of ARIF compared with ORIF.