Knee Stiffness After Tibial Plateau Fractures: Predictors and Outcomes (OTA-41)

J Orthop Trauma. 2018 Nov;32(11):e421-e427. doi: 10.1097/BOT.0000000000001304.


Objectives: What patient characteristics and injury factors predict decreased knee range of motion (ROM) after operative management of tibial plateau fractures?

Design: Prospective cohort study.

Setting: Academic medical center.

Patients: Over 11 years, tibial plateau fractures at a single academic institution were prospectively followed. A total of 266 patients were included in this study.

Intervention: Surgical repair of tibial plateau fractures and secondary interventions due to arthrofibrosis.

Main outcome measure: Clinical outcomes were evaluated using the Short Musculoskeletal Function Assessment and ROM at 3-month, 6-month, and long-term follow-up. Secondary outcomes were considered as the need for a subsequent procedure due to arthrofibrosis.

Results: At 3-month follow-up, the mean ROM was 113 degrees. By long-term follow-up (mean = 17 months), the mean ROM improved to 125 degrees. Independent predictors of decreased knee ROM were the following: at 3-month follow-up, open fractures (P = 0.047), application of a knee-spanning external fixator (P = 0.026), orthopaedic polytrauma (P = 0.003), and tibial spine involvement (P = 0.043); and at long-term follow-up, nonwhite ethnicity (P = 0.003), increasing age (P = 0.003), and a deep infection (P = 0.002). Ten patients (3.7%) required a secondary procedure for arthrofibrosis. There was a significant improvement in the knee ROM (P < 0.001) and functional outcomes (P = 0.004) following the intervention.

Conclusions: At long-term follow-up, independent predictors of decreased knee ROM were nonwhite ethnicity, increasing age, and sustaining a postoperative complication of a deep infection. Secondary interventions were reliable treatments for arthrofibrosis.

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

MeSH terms

  • Academic Medical Centers
  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Fibrosis / etiology
  • Fibrosis / surgery
  • Follow-Up Studies
  • Fracture Fixation, Internal / adverse effects*
  • Fracture Fixation, Internal / methods
  • Humans
  • Intra-Articular Fractures / complications
  • Intra-Articular Fractures / surgery
  • Knee Injuries / diagnostic imaging
  • Knee Injuries / surgery*
  • Male
  • Menisci, Tibial / surgery*
  • Middle Aged
  • Postoperative Complications / pathology*
  • Postoperative Complications / surgery
  • Prospective Studies
  • Range of Motion, Articular / physiology*
  • Reoperation / methods
  • Risk Assessment
  • Tibial Fractures / diagnostic imaging
  • Tibial Fractures / surgery*
  • Time Factors
  • Young Adult