A comparative analysis of arthroscopy-assisted minimally invasive percutaneous plate osteosynthesis versus open reduction and internal fixation for tibial plateau fractures.

Abstract

Objectives: This study aims to investigate whether arthroscopy-assisted minimally invasive percutaneous plate osteosynthesis (MIPPO) provided more favorable early functional recovery and reduced surgical trauma compared to traditional open reduction and internal fixation (ORIF).

Patients and methods: A total of 84 patients with Schatzker type I-IV tibial plateau fractures treated between January 2021 and January 2024 were retrospectively analyzed. The MIPPO group (n = 41) underwent arthroscopy-assisted reduction plus MIPPO, while the ORIF group (n = 43) received conventional ORIF. Allocation was chronological, with ORIF predominant in the first two years and MIPPO in the latter two years. Operative parameters, postoperative drainage, radiographic outcomes (Rasmussen radiological score), functional recovery (Hospital for Special Surgery [HSS] score), range of motion (ROM), fracture healing time, hospital stay, and complications were compared.

Results: Of a total of 84 patients, 28 were male and 56 were female of 49.4 ± 9.0 (range, 27 to 69) years. The arthroscopy-assisted MIPPO group had significantly longer operative time (96.0 ± 18.2 vs. 84.0 ± 13.9 min, p = 0.001) but shorter incision length (3.9 ± 0.7 vs. 6.2 ± 0.9 cm, p < 0.001), less intraoperative blood loss (56.5 ± 9.6 vs. 72.6 ± 10.1 mL, p < 0.001), and lower postoperative drainage volume (47.1 ± 7.5 vs. 59.0 ± 7.0 mL, p < 0.001) than the ORIF group. The arthroscopy-assisted MIPPO group also achieved higher Rasmussen radiological scores (15.4 ± 1.4 vs. 14.0 ± 1.6, p < 0.001) and better HSS scores at one, three, and six months postoperatively (all p < 0.001). At six months postoperatively, the MIPPO group also demonstrated significantly improved knee ROM (118.5° ± 8.2° vs. 107.3° ± 9.1°, p < 0.001), a difference exceeding the clinically meaningful threshold for activities of daily living. However, no significant differences were found in hospital stay (p = 0.051), fracture healing time (11.4 ± 1.3 vs. 11.1 ± 1.3 weeks, p = 0.340), or the excellent-and-good rate of HSS score at final follow-up (95.1% vs. 97.7%, p = 0.746). Complication rates were similar between the groups (p = 1.000).

Conclusion: For Schatzker type I-IV tibial plateau fractures, arthroscopy-assisted MIPPO provides more favorable early functional recovery and radiological reduction quality compared to conventional ORIF, with less surgical trauma and comparable early functional recovery and similar complication rates during follow-up. Although operative time is longer, this minimally invasive approach is a safe and effective option for managing these complex fractures. Its principal advantage is accelerated early recovery, particularly in knee ROM, enabling patients to reach clinically meaningful thresholds for activities of daily living sooner.