Systematic Reviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2017; 8(7): 574-587
Published online Jul 18, 2017. doi: 10.5312/wjo.v8.i7.574
Return to sport following tibial plateau fractures: A systematic review
Greg A J Robertson, Seng J Wong, Alexander M Wood
Greg A J Robertson, Seng J Wong, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland EH16 4SA, United Kingdom
Alexander M Wood, Orthopaedic Department, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom
Author contributions: Robertson GAJ, Wong SJ and Wood AM conceived the methodology for the manuscript, performed the literature search and analyses for the study, and wrote the manuscript.
Conflict-of-interest statement: Greg A J Robertson, Seng J Wong and Alexander M Wood have no conflicts of interest to declare. Neither has received fees for serving as a speaker or a consultant for commercial organisations. Neither has received research funding from commercial organisations. Both are employees of the United Kingdom National Health Service, though not of any commercial organisations. Neither owns stocks or shares in related.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at The dataset consisted of anonymised synthesis evidence from published studies. Thus no informed consent for data sharing was required.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Greg A J Robertson, MBChB, BMedSci(Hons), MSc, MRCSEd, Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland EH16 4SA, United Kingdom.
Telephone: +44-131-2423545 Fax: +44-131-2423541
Received: January 28, 2017
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.

Keywords: Tibial, Plateau, Fracture, Knee, Return, Sport, Rate, Time

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.