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INTRODUCTION: Patients who sustain a tibial plateau fracture (TPF) have a higher risk of receiving total knee arthroplasty (TKA). Rarely, TKA is used as acute treatment for TPFs. This study aimed to compare both acute and delayed TKA following TPF with matched patients undergoing elective TKA for osteoarthritis. MATERIALS AND METHODS: A retrospective study was conducted including patients with either acute TKA as the primary treatment for TPF, or unplanned delayed TKA due to posttraumatic osteoarthritis. Both groups were matched to controls undergoing TKA for osteoarthritis. Questionnaires were completed cross-sectionally. Knee injury and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS), Oxford Knee Score (OKS), EQ-5D-5L, and complications were compared. RESULTS: Thirty-four TPF patients (12 acute TKA, 22 delayed TKA) were matched 1:1. Mean age was 67.2 ± 9.9 years, 82% was female, and mean follow-up was 5.0 ± 2.9 years. No differences were found for the acute group compared to their controls (median KOOS-PS 73.1 vs. 69.3, p = 0.977; median OKS 43 vs. 45, p = 0.246; median EQ-5D-5L 0.87 vs. 1.00, p = 0.078). In the delayed group, scores were inferior compared to their controls (median KOOS-PS 63.9 vs 78.0, p = 0.003; median OKS 39 vs 44, p = 0.001; median EQ-5D-5L 0.81 vs 0.87, p = 0.008). Complications showed no significant differences. CONCLUSION: Acute TKA for TPF shows no difference to a matched group of elective TKA, but delayed TKA following TPF yields worse results at mean 5-year follow-up. This suggests that TPFs in patients with a high risk of ultimately requiring TKA may benefit from primary treatment with TKA.

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PURPOSE: Injuries of the anterior cruciate ligament (ACL) are common knee injuries among active and younger patients. The Lever Sign Test (LST) is a relatively newer test, of which the accuracy is disputed in the existing literature. The aim of this study was to assess the accuracy with and without anesthesia of the Lever Sign test in the literature. METHODS: PRISMA guidelines were followed, studies were identified using PubMed, EMBASE and Google Scholar. All studies that reported accuracy of LST performed by a clinical professional were included. Integrity of ACL was confirmed using magnetic resonance imaging or arthroscopy. Sensitivity and specificity were calculated using uni- and bivariate methods. RESULTS: After inclusion, 3299 observations in 2516 patients were included from 23 studies. Mean age was 31.8 years and 64.2% were male. Without anesthesia, sensitivity was 79.2% (95% CI 68.7-86.9) and specificity was 92.0% (95% CI 82.2-96.6). An area under the curve (AUC) of 86.1% was found. With anesthesia, sensitivity was 86.6% (95% CI 68.0-95.2), specificity was 93.4% (95% CI 84.5-97.3) and the AUC was 91.6%. CONCLUSION: The Lever Sign test shows very good to excellent accuracy for ACL injury, and is a useful tool for clinical practice.

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In older patients with highly comminuted intra- articular tibial plateau fractures (TPFs), primary total knee arthroplasty (TKA) may be a treatment option. Our aim was to report and rank decisional factors considered by Dutch orthopaedic trauma and knee surgeons that may lead to the decision for TKA as treatment for TPFs. A survey was distributed among 141 experts on traumatology and arthroplasty of the knee. The survey assessed the likelihood of TKA surgery after TPF in various patient and radiological characteristics. The level of experience with this of each responder was also noted. Descriptive statistics were calculated for all items. 141 participants were approached and 68 responded (48.2%). Responders were not more likely to proceed with TKA based on fracture types, impaired mobility, multiple incisions for ORIF, body mass index and ASA classification. However, in patients with pre-existing osteoarthritis (OA) and age ≥ 80 a majority would be more likely to proceed with TKA, with respectively 69.1% and 50.0%. The most strongly considered factors were the presence of pre-existing OA, the age of the patient and the type of fracture, with respectively 55.9%, 51.4% and 42.6% of responders ranking it in their top three most important factors. The study showed that the presence of pre-existing symptomatic OA and age of the patient were valued highest and increased the probability of a TKA in acute TPFs.

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