Published online Jul 18, 2017. doi: 10.5312/wjo.v8.i7.574
Peer-review started: February 12, 2017
First decision: March 28, 2017
Revised: April 3, 2017
Accepted: April 23, 2017
Article in press: April 24, 2017
Published online: July 18, 2017
To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods.
A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords “tibial”, “plateau”, “fractures”, “knee”, “athletes”, “sports”, “non-operative”, “conservative”, “operative”, “return to sport”. All studies which recorded return rates and times to sport following tibial plateau fractures were included.
Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management (n = 3); 27 reported on the outcome of surgical management (n = 917). Nine studies reported on Open Reduction Internal Fixation (ORIF) (n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation (ARIF) (n = 253) and 7 on Frame-Assisted Fixation (FRAME) (n = 262). All studies recorded “return to sport” rates. Only one study recorded a “return to sport” time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF (OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME (OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME (OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo (median), from a study reporting on ORIF.
Return rates to sport for tibial plateau fractures remain limited compared to other fractures. ARIF provides the best return rates. There is limited data regarding return times to sport. Further research is required to determine return times to sport, and to improve return rates to sport, through treatment and rehabilitation optimisation.
Core tip: We performed a systematic review assessing all studies which reported return rates and times to sport following tibial plateau fractures. Twenty-seven studies were included: All recorded return rates; only one study recorded return times. One study reported on conservative treatment; all 27 studies reported on surgical treatment. The surgical techniques comprised Open Reduction Internal Fixation (ORIF), Arthroscopic-Assisted Reduction Internal Fixation (ARIF) and Frame-Assisted Fixation (FRAME). The return rates were: Total Cohort-70%; conservatively-managed cohort-100%; surgically-managed cohort-70%; ORIF-60%, ARIF-83%, FRAME-52%. ARIF provided the best return rates to sport. Data however is limited, particularly for return times to sport. Further research in this area is required.