An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries
High-energy anterior cruciate ligament (high-energy ACL) injury, occurring in high-energy rotatory trauma of the knee, can accompany a unique fracture pattern that involves depression of the slope of the posterolateral tibial plateau (PLTP). These injuries are challenging to manage due to the lack o...
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2020-09-01
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doaj-e42fcaf00d3040f295527205d611eed62021-06-11T05:13:20ZengElsevierArthroscopy Techniques2212-62872020-09-0199e1249e1258An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament InjuriesJ. Patrick Park, M.Sc.0Carl Laverdière, B.Eng.1Jason Corban, M.D., C.M.2Jens Böttcher, M.D.3Mark L. Burman, M.D., C.M.4Ryan Martin, M.D.5Paul A. Martineau, M.D., C.M.6Division of Orthopaedic Surgery, McGill University Health Center, Montreal, Quebec; Address correspondence to J. Patrick Park, M.Sc., McGill University Health Center, Montreal General Hospital, 1650 Cedar Ave., A5.175, Montreal, Quebec, Canada H3G 1A4.Division of Orthopaedic Surgery, McGill University Health Center, Montreal, QuebecDivision of Orthopaedic Surgery, McGill University Health Center, Montreal, QuebecDivision of Orthopaedic Surgery, McGill University Health Center, Montreal, QuebecDivision of Orthopaedic Surgery, McGill University Health Center, Montreal, QuebecDivision of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, CanadaDivision of Orthopaedic Surgery, McGill University Health Center, Montreal, QuebecHigh-energy anterior cruciate ligament (high-energy ACL) injury, occurring in high-energy rotatory trauma of the knee, can accompany a unique fracture pattern that involves depression of the slope of the posterolateral tibial plateau (PLTP). These injuries are challenging to manage due to the lack of a gold-standard arthroscopic procedure that addresses both ACL deficiency and depressed PLTP slope. In such injuries, a one-stage approach may be used to (1) reconstruct the ACL or (2) reduce and fix the avulsed tibial spine, while concomitantly performing an arthroscopy-assisted reduction of a PLTP fracture that restores the anatomic slope of the tibial plateau. To summarize, using combined arthroscopic and fluoroscopic visualization, a tibial tunnel reaching 1 cm distal to the depressed plateau fragment is created using a cannulated drill. The drill is used to punch up the depressed fragment to its anatomic location, restoring the original slope of the PLTP. The corrected slope is then fixed in situ using a press-fit fibular allograft to stabilize the corrected PLTP slope. Use of this minimally invasive arthroscopic technique to restore the PLTP slope may help prevent graft failure of the reconstructed ACL and improve patient outcomes.http://www.sciencedirect.com/science/article/pii/S221262872030116X |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
J. Patrick Park, M.Sc. Carl Laverdière, B.Eng. Jason Corban, M.D., C.M. Jens Böttcher, M.D. Mark L. Burman, M.D., C.M. Ryan Martin, M.D. Paul A. Martineau, M.D., C.M. |
spellingShingle |
J. Patrick Park, M.Sc. Carl Laverdière, B.Eng. Jason Corban, M.D., C.M. Jens Böttcher, M.D. Mark L. Burman, M.D., C.M. Ryan Martin, M.D. Paul A. Martineau, M.D., C.M. An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries Arthroscopy Techniques |
author_facet |
J. Patrick Park, M.Sc. Carl Laverdière, B.Eng. Jason Corban, M.D., C.M. Jens Böttcher, M.D. Mark L. Burman, M.D., C.M. Ryan Martin, M.D. Paul A. Martineau, M.D., C.M. |
author_sort |
J. Patrick Park, M.Sc. |
title |
An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries |
title_short |
An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries |
title_full |
An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries |
title_fullStr |
An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries |
title_full_unstemmed |
An Arthroscopic Procedure for Restoration of Posterolateral Tibial Plateau Slope in Tibial Plateau Fracture Associated With Anterior Cruciate Ligament Injuries |
title_sort |
arthroscopic procedure for restoration of posterolateral tibial plateau slope in tibial plateau fracture associated with anterior cruciate ligament injuries |
publisher |
Elsevier |
series |
Arthroscopy Techniques |
issn |
2212-6287 |
publishDate |
2020-09-01 |
description |
High-energy anterior cruciate ligament (high-energy ACL) injury, occurring in high-energy rotatory trauma of the knee, can accompany a unique fracture pattern that involves depression of the slope of the posterolateral tibial plateau (PLTP). These injuries are challenging to manage due to the lack of a gold-standard arthroscopic procedure that addresses both ACL deficiency and depressed PLTP slope. In such injuries, a one-stage approach may be used to (1) reconstruct the ACL or (2) reduce and fix the avulsed tibial spine, while concomitantly performing an arthroscopy-assisted reduction of a PLTP fracture that restores the anatomic slope of the tibial plateau. To summarize, using combined arthroscopic and fluoroscopic visualization, a tibial tunnel reaching 1 cm distal to the depressed plateau fragment is created using a cannulated drill. The drill is used to punch up the depressed fragment to its anatomic location, restoring the original slope of the PLTP. The corrected slope is then fixed in situ using a press-fit fibular allograft to stabilize the corrected PLTP slope. Use of this minimally invasive arthroscopic technique to restore the PLTP slope may help prevent graft failure of the reconstructed ACL and improve patient outcomes. |
url |
http://www.sciencedirect.com/science/article/pii/S221262872030116X |
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