The Midline Lateral Parapatellar Arthrotomy: A Safe Alternative Approach for Lateral Tibial Plateau Fractures.

Abstract

The midline lateral parapatellar (LP) approach has been shown in a cadaveric study to provide superior articular exposure compared with the anterolateral approach (AL). The purpose of this study was to report on outcomes and complications with the LP approach. Retrospective comparative cohort study and prospective cohort. Academic Level-I trauma center. Adult patients with minimum 3 months follow-up who underwent open reduction internal fixation of an acute, isolated lateral tibial plateau fracture (OTA/AO 41-B1, 41-B2, 41-B3) through an LP arthrotomy or AL submeniscal arthrotomy between 2010 and 2019. Retrospective cohort evaluated using postoperative complications including infection, delayed wound healing, and reoperation rate. Prospective cohort evaluated using Short Musculoskeletal Function Assessment, knee range of motion, and complications. A total of 81 patients were studied. The mean age for the LP cohort was 41.5 years (19-79) and 18 of 32 (56.3%) patients were men. The mean age for the AL cohort was 42.8 years (18-71) and 29 of 49 (59.2%) patients were men. The mean age for patients in the prospective study was 31.4 years (19-59) and 9 of 14 (64.3%) patients were men. Mean follow-up was 9.3 months and 20.3 months for the retrospective and prospective cohorts, respectively. There was no significant difference in complication or reoperation rate ( P > 0.39). For the prospective cohort of 14 patients, mean range of motion was 130 degrees. Mean Short Musculoskeletal Function Assessment dysfunction index was 9.0 and mean bother index was 11.1. The LP approach resulted in comparable clinical and functional outcomes with those reported with the anterolateral approach. It is a safe alternative and may be of most benefit when treating comminuted lateral tibial plateau fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.