Return to sport following tibial plateau fractures: A systematic review

doi:10.5312/wjo.v8.i7.574

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World Journal of Orthopedics

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Systematic Reviews

World J Orthop. Jul 18, 2017; 8(7): 574-587
Published online Jul 18, 2017. doi: 10.5312/wjo.v8.i7.574

Table 1 Inclusion and exclusion criteria

Inclusion criteria	Exclusion criteria
Acute tibial plateau fractures	Extra-articular proximal tibial fractures
Elite or recreational athletes	Stress fractures of the proximal tibial
Return rate to sporting activity reported	No sporting outcome data reported
Return time to sporting activity reported	Paediatric fractures (age under 15)
Two or more fractures reported	Reviews, case reports, abstracts or anecdotal articles
Peer-reviewed journals	Animal, cadaver or in vitro studies
English language

Table 2 Conservatively managed fractures - only patients with follow-up data included

Ref.	N	Study design	Mean follow-up	Treatment	Mode of injury	Fracture types	Report of IA injuries	IA injury repair	Coleman score	Return rate	Return rate by treatment modality	Return rate to same level of sport	Return time (range)	Rate of union	Time to union (range)
Waldrop et al[18] (1988)	3	RCS	59 mo	Knee immobilisation	Falls RTA skiing	Postero-lateral (undisplaced)	Yes	Yes	69	3/3 (100%)	Cons: 3/3 (100%)	3/3 (100%)	N/A	N/A	N/A

Mean values unless otherwise stated. RCS: Retrospective cohort study; RTA: Road traffic accident; Cons: Conservative; N/A: No data available; IA: Intra-articular.

Table 3 Fractures treated by Open Reduction Internal Fixation - only patients with follow-up data included

Ref.	n	Study design	Mean follow-up	Treatment	Mode ofinjury	Fracture types	Report of IA injuries	IA injury repair	Coleman score	Return rate	Return rate bytreatment modality	Return rate tosame level of sport	Return time (range)	Rate of union	Time tounion (range)
Ahearn et al[12] (2014)	21	RCS	40.5 mo	PF (21)	Falls RTA pedestrian	Schatzker VI Bicondylar	No	Not reported	62	14/21 (67%)	PF: 14/21 (67%)	4/21 (19%)	N/A	21/21 (100%)	N/A
Brunner et al[19] (2009)	5	CS	39 mo	PF (5)	Skiing (4) Falls (1)	Moore type II	Yes	Yes	61	5/5 (100%)	PF: 5/5 (100%)	N/A	N/A	N/A	N/A
Canadian Orthopaedic Trauma Society[11] (2006)	33	RCT	24 mo	PF (33)	Falls RTA Pedestrian Sports Work Cycling	Schatzker V and VI	Yes	Yes	74	4/33 (12%)	PF: 4/33 (12%)	4/33 (12%)	N/A	N/A	N/A
Chang et al[16] (2014)	16	PCS	28.7 mo	PF (16)	N/A	Schatzker VI AO/OTA C2-3	Yes	Yes	66	14/16 (88%)	PF: 14/16 (88%)	14/16 (88%)	N/A	16/16 (100%)	20.2 wk
Keogh et al[13] (1992)	13	RCS	17 mo	PSF (13)	RTA (5) Falls (5) Work (2) Sport (1)	Schatzker I-VI	No	Not reported	45	11/13 (85%)	PSF: 11/13 (85%)	N/A	N/A	N/A	N/A
Morin et al[14] (2016)	15	PCS	18.2 mo	SF (15)	Skiing (15)	Postero-Medial Moore Type I	Yes	Yes	73	13/15 (87%)	SF: 13/15 (87%)	0/15 (0%)	N/A	N/A	N/A
Stevens et al[17] (2001)	46	RCS	100 mo	PF (46)	RTA (13) Pedestrian (13) Falls (9) Sports (6) Work (2)	Schatzker I-VI	Yes	Yes	70	21/46 (46%)	PF: 21/46 (46%)	6/46 (13%)	N/A	46/46 (100%)	N/A
van Dreumel et al[15] (2015)	26	RCS	74 mo	SF PF	Falls (57%) RTA (25%) Other (14%)	Schatzker I-VI AO/OTA B1-C3	No	Not reported	79	15/26 (58%)	SF: N/A PF: N/A	15/26 (58%)	6.9 (2-18) mo (median)	N/A	N/A
Waldrop et al[18] (1988)	3	RCS	59 mo	PF (6) ORBG (12)	Falls RTA Skiing	Postero-Lateral (displaced)	Yes	Yes	69	18/18 (100%)	PF: 6/6 (100%) ORBG: 12/12 (100%)	17/18 (100%)	N/A	N/A	N/A

Mean values unless otherwise stated. RCS: Retrospective cohort study; PCS: Prospective cohort study; RCT: Randomised controlled trial; CS: Case series; ORIF: Open reduction internal fixation; PF: Plate fixation; SF: Screw fixation; PSF: Percutaneous screw fixation; ORBG: Open reduction and bone grafting; RTA: Road traffic accident; Pedestrian - Pedestrian struck by Motor Vehicle; AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association; N/A: No data available; IA: Intra-articular.

Table 4 Fractures treated by Arthroscopic-Assisted Reduction and Internal Fixation - Only patients with follow-up data included

Ref.	n	Study design	Mean follow-up	Treatment	Mode of injury	Fracture types	Report of IA injuries	IA injury repair	Coleman score	Return rate	Return rate by treatment modality	Return rate to same level of sport	Return time (range)	Rate of union	Time to union (range)
Chan et al[26] (2003)	18	PCS	48 mo	APF (18)	RTA (17) Falls (1)	Schatzker V and VI	Yes	Yes	68	13/18 (72%)	APF: 13/18 (72%)	13/18 (72%)	N/A	N/A	N/A
Chan et al[25] (2008)	54	PCS	87 mo	APF (54)	RTA (50) Falls (4)	Schatzker I-VI	Yes	Yes	80	48/54 (89%)	APF: 48/54 (89%)	48/54 (89%)	N/A	54/54 (100%)	N/A
Chiu et al[34] (2013)	25	RCS	86 mo	APF (25)	N/A	Schatzker IV-VI	Yes	Yes	73	22/25 (88%)	APF: 22/25 (88%)	22/25 (88%)	N/A	25/25 (100%)	N/A
Duan et al[29] (2008)	39	RCS	34 mo	APSF (37)	RTA (19) Falls (11) Sports (9)	Schatzker I-V	Yes	Yes	57	30/39 (77%)	APSF: 30/39 (77%)	30/39 (77%)	N/A	39/39 (100%)	12 (11-14) wk
Gill et al[28] (2001)	25	PCS	24 mo	APSF (25)	Skiing (25)	Schatzker I-IV	Yes	Yes	79	21/25 (84%)	APSF: 21/25 (84%)	21/25 (84%)	N/A	N/A	N/A
Guanche et al[31] (1993)	5	CS	N/A	APSF (5)	N/A	Schatzker I-III	No	Not reported	55	5/5 (100%)	APSF: 5/5 (100%)	5/5 (100%)	N/A	5/5 (100%)	N/A
Holzach et al[30] (1994)	15	PCS	35.3 mo	APSF (10)	Skiing (15)	AO/OTA B2.2 and B3.1	Yes	Yes	76	13/15 (87%)	APSF: 13/15 (87%)	13/15 (87%)	N/A	N/A	N/A
Hung et al[32] (2003)	31	PCS	36 mo	APF (31)	RTA (30) Falls (1)	Schatzker I-VI	Yes	Yes	76	26/31 (84%)	APF: 26/31 (84%)	26/31 (84%)	N/A	31/31 (100%)	12 (11-14) wk
Itokazu et al[24] (1996)	16	RCS	30 mo	APSF (5) ACF (7) APF (4)	N/A	Hohl II and III	Yes	Yes	49	16/16 (100%)	APSF: 5/5 (100%) ACF: 7/7 (100%) APF: 4/4 (100%)	16/16 (100%)	N/A	16/16 (100%)	N/A
Kampa et al[27] (2016)	20	RCS	30 mo	APSF (20)	Falls (52%) Sport (48%)	Schatzker I-III	Yes	Yes	71	10/20 (50%)	APSF: 10/20 (50%)	10/20 (50%)	N/A	20/20 (100%)	N/A
Pizanis et al[33] (2012)	5	CS	24 mo	APF (5)	N/A	AO/OTA B2 and B3	No	Not reported	61	5/5 (100%)	APF: 5/5 (100%)	5/5 (100%)	N/A	N/A	N/A

Mean values unless otherwise stated. RCS: Retrospective cohort study; PCS: Prospective Cohort Study; CS: Case series; APSF: Arthroscopic-assisted reduction and percutaneous screw fixation; ACF: Arthroscopic-assisted reduction and cement filling; APF: Arthroscopic-assisted plate fixation; RTA: Road traffic accident; AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association; NA: No data available; IA: Intra-articular.

Table 5 Fractures treated by frame application - only patients with follow-up data included

Ref.	n	Study design	Mean follow-up	Treatment	Mode of injury	Fracture types	Report of IA injuries	IA injury repair	Coleman score	Return rate	Return rate by treatment modality	Return rate to same level of sport	Return time (range)	Rate of union	Time to union (range)
Ahearn et al[12] (2014)	15	RCS	41 mo	Frame and IF (15) Non-Bridging Frames (15)	Falls RTA Pedestrian	Schatzker VI (Bicondylar)	No	Not reported	62	11/15 (73%)	Frame and IF: 11/15 (73%)	3/15 (20%)	N/A	15/15 (100%)	N/A
Chin et al[20] (2005)	18	RCS	28 mo	Frame and IF (16) Arthro Frame (2) Bridging Frames (3) Non-Bridging Frames (15)	RTA Pedestrian Falls Skiing Cycling	Schatzker V and VI	No	Not reported	61	15/18 (83%)	Frame and IF: N/A Arthro Frame: N/A	7/18 (39%)	N/A	15/18 (83%)	14 (11-22) wk
Canadian Orthopaedic Trauma Society[11] (2006)	33	RCT	24 mo	Frame and IF (33) Bridging Frames (4) Non-Bridging Frames (29)	Falls RTA Pedestrian Sports Work Cycling	Schatzker V and VI	Yes	Yes	74	10/33 (30%)	Frame and IF: 10/33 (30%)	10/33 (30%)	N/A	N/A	N/A
Itokazu et al[24] (1996)	1	RCS	30 mo	Arthro Frame (1) Non-Bridging Frame (1)	N/A	Hohl II and III	Yes	Yes	49	1/1 (100%)	Arthro Frame: 1/1 (100%)	1/1 (100%)	N/A	1/1 (100%)	N/A
Katsenis et al[21] (2005)	46	RCS	38 mo	Frame and IF (46) Bridging Frames (30) Non-Bridging Frames (16)	RTA Falls	Schatzker V and VI AO/OTA C1-3	Yes	Not reported	72	25/46 (54%)	Frame and IF: 25/46 (54%)	N/A	N/A	45/46 (98%)	13.5 (11-18) wk
Katsenis et al[22] (2009)	127	RCS	60 mo (minimum)	Frame and IF (127) Bridging and Non-Bridging Frames (127)	RTA (96) Falls (29) Sports (2)	AO/OTA C1-3	Yes	Not reported	68	68/127 (54%)	Frame and IF: 68/127 (54%)	N/A	N/A	126/127 (99%)	13.7 (10-20) wk
Weigel et al[23] (2002)	22	RCS	98 mo	Frame and IF (22) Non-Bridging Frames (22)	RTA (16) Fall (3) Pedestrian (2) Assault (1) Sport (1) Crush (1)	Schatzker II, IV, V and VI AO/OTA C1-3	No	Not reported	54	7/22 (32%)	Frame and IF: 7/22 (32%)	N/A	N/A	N/A	N/A

Mean values unless otherwise stated. RCS: Retrospective cohort study; PF: Plate fixation, PSF: Percutaneous screw fixation; APSF: Arthroscopic Percutaneous screw fixation; Arthro Frame: Arthroscopic-assisted frame application; Arthro Frame and IF: Arthroscopic-assisted frame application with internal fixation; RTA: Road traffic accident; AO/OTA: Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association; N/A: Data not available; IA: Intra-articular.

Table 6 Surgical cohorts with combined outcome data - only patients with follow-up data included

Ref.	n	Study design	Mean follow-up	Treatment	Mode of injury	Fracture types	Report of IA injuries	IA injury repair	Coleman score	Return rate	Return rate by treatment modality	Return rate to same level of sport	Return time (range)	Rate of union	Time to union (range)
Kraus et al[36] (2012)	79	RCS	53 mo	PF PSF APSF	Sports (54%) RTA (20%) Falls (18%)	Schatzker I-VI AO/OTA A2-C3	Yes	Yes	47	65/79 (82%)	ORIF: N/A PSF: N/A APSF: N/A	N/A	N/A	N/A	N/A
Loibl et al[37] (2013)	92	RCS	94 mo	PF PSF ARSF	Skiing (92)	AO/OTA B1-C3	No	Not reported	55	81/92 (88%)	ORIF: N/A PSF: N/A APSF: N/A	57/92 (62%)	N/A	N/A	N/A
Scheerlinck et al[35] (1998)	38	RCS	62 mo	APSF (30) Arthro Frame (2) Arthro Frame and IF (6)	N/A	AO/OTA B1-C3	Yes	Yes	68	32/38 (84%)	APSF: N/A Arthro Frame: N/A Arthro Frame and IF: N/A	24/38 (63%)	N/A	N/A	N/A

Mean values unless otherwise stated. RCS: Retrospective cohort study; PF: Plate fixation; PSF: Percutaneous screw fixation; APSF: Arthroscopic percutaneous screw fixation; Arthro frame: Arthroscopic-assisted frame application; Arthro frame and IF: Arthroscopic-assisted frame application with internal fixation; RTA: Road traffic accident; AO/OTA: Arbeitsgemeinschaft für osteosynthesefragen/orthopaedic trauma association; N/A: Data not available; IA: Intra-articular.

Table 7 Summary of the return times to sport, return rates to sport, times to union and rates of union by treatment modality

Mode of treatment	n (total)	Return rates to sport	Return times to sport	Return rate to pre-injury level	Rates of union	Mean times to union
All[11-37]	920	642/920 (70%)[11-37]	6.9 mo (median)[15]	374/628 (60%)[11,12,14-18,20,24-35,37]	475/480 (99%)[12,16,17,20-22,24-27,29,31,34]	13.6 wk[16,20-22,29,32]
Non-surgical[18]	3	3/3 (100%)[18]	N/A	3/3 (100%)[18]	N/A	N/A
Surgical[11-37]	917	639/917 (70%)[11-37]	6.9 mo (median)[15]	371/625 (59%)[11,12,14-18,20,24-35,37]	475/480 (99%)[12,16,17,20-22,24-27,29,31,34]	13.6 wk[16,20-22,29,32]
Surgical
ORIF[11-19]	193	115/193 (60%)[11-19]	6.9 mo (median)[15]	60/175 (34%)[11,12,14-18]	83/83 (100%)[12,16,17]	20.2 wk[16]
ARIF[24-34]	253	209/253 (83%)[24-34]	N/A	209/253 (83%)[24-34]	190/190 (100%)[24-27,29,31,34]	12.0 wk[29,32]
FRAME[11,12,20-24]	262	137/262 (52%)[11,12,20-24]	N/A	21/67 (31%)[11,12,20,24]	202/207 (98%)[12,20-22,24]	13.7 wk[20-22]
Non-specific surgical cohort[35-37]	209	178/209 (85%)[35-37]	N/A	81/130 (62%)[35,37]	N/A	N/A

ORIF: Open Reduction Internal Fixation; ARIF: Arthroscopic-Assisted Reduction Internal Fixation; FRAME: Frame-Assisted Fixation; NA: No data available.

Citation: Robertson GAJ, Wong SJ, Wood AM. Return to sport following tibial plateau fractures: A systematic review. World J Orthop 2017; 8(7): 574-587
URL: https://www.wjgnet.com/2218-5836/full/v8/i7/574.htm
DOI: https://dx.doi.org/10.5312/wjo.v8.i7.574