VIS-IT: Visualizing the Injured Tibia—A Cadaveric Study of Limb Positioning for Posterolateral Tibial Plateau Fracture Visualization

Joseph K. Kendal; Damian Clark; David Longino; Travis E. Marion; Richard Buckley; Prism S. Schneider; Ryan Martin

doi:10.1055/s-0038-1676799

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2020; 33(02): 132-137
DOI: 10.1055/s-0038-1676799

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

VIS-IT: Visualizing the Injured Tibia—A Cadaveric Study of Limb Positioning for Posterolateral Tibial Plateau Fracture Visualization

Joseph K. Kendal

¹Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada

,

Damian Clark

¹Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada

²Department of Orthopaedics, Southmead Hospital, Bristol, United Kingdom

,

David Longino

¹Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada

,

Travis E. Marion

¹Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada

³Division of Orthopaedic Surgery, Clinical Affiliate with the Northern Ontario School of Medicine, Sudbury, Ontario, Canada

,

Richard Buckley

¹Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada

,

Prism S. Schneider

¹Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada

,

Ryan Martin

¹Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Health Sciences Center, Northwest Calgary, Alberta, Canada

› Author Affiliations

Abstract

Posterolateral tibial plateau (PLTP) fractures are often associated with anterior cruciate ligament (ACL) incompetence, such as tibial eminence fractures. Both occur from a pivot shift like mechanism. Malreductions of the tibial plateau most frequently occur in the posterolateral quadrant. Acquiring adequate intraoperative visualization of the PLTP poses a challenge. We hypothesized that visualization of PLTP could be improved by positioning the knee at 110 degrees of flexion with the addition of a varus anterolateral rotatory vector. This position and maneuver take advantage of both the nonisometric nature of the lateral soft tissues and, when present, ACL incompetence. In this cadaveric study, we digitally quantified the percentage of the lateral tibial plateau visualized under different conditions after performing an anterolateral surgical approach with submeniscal arthrotomy. Four conditions were assessed for articular visualization: (1) 30 degrees of knee flexion, (2) 110 degrees of knee flexion, (3) 110-degrees of knee flexion plus varus anterolateral rotatory vector, (4) 110-degrees of knee flexion plus varus anterolateral rotatory vector with ACL sacrifice (ACL incompetence model). In the ACL competent models, maximal lateral tibial plateau exposure was obtained with the knee positioned at 110 degrees of flexion with a varus anterolateral rotatory vector (58.2%, range: 52.9–63.4%). Articular visualization was further improved with the ACL incompetent model (82.4%, range: 77.1–87.7%), modeling a tibial eminence fracture.

Keywords

tibial plateau fracture - surgical approach - posterolateral - cadaver

Full Text

References

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