Outcomes of arthroscopic-assisted lateral tibial plateau fixation: a systematic review

Purpose: The purpose of this study is to evaluate and summarize the current literature on outcomes of arthroscopic-assisted tibial plateau fixation (AATPF) when applied for only lateral tibial plateau fractures. Methods: A comprehensive search of nine databases was conducted: ClinicalTrials.gov, Cochrane Library via Wiley, Embase and MEDLINE via Ovid, Global Index Medicus, PubMed, Scopus, SPORTDiscus via EBSCO, and Web of Science Core Collection. The study was performed in concordance with PRISMA guidelines. Studies eligible for inclusions included Schatzker I–III lateral tibial plateau fractures with a minimum of 6-month follow-up. Data extraction was performed by two authors independently using a predesigned form. Results: A total of 17 studies, 7 prospective and 10 retrospective, including 565 patients (age 15–82 years old) treated with AATPF were included in this review with follow-up ranging from 6 to 138 months. All 10 studies that used categorical functional outcomes demonstrated excellent/very good or good outcomes in > 90% of patients. When compared to patients managed with the traditional open reduction internal fixation (ORIF), patients treated with AATPF had statistically significantly better range of motion mean difference [5.21° (95% CI − 2.50 to 12.92, p < 0.0001)], lower blood loss [66.19 mL (95% confidence interval (CI) 32.54–99.84 mL, p < 0.0001)], shorter hospital stay [− 1.41 days (95% CI − 3.39 to 0.58 days, p < 0.0001)], better Hospital Special Surgery score [11.31 (95% CI 6.49–16.12, p < 0.0001)], and higher Rasmussen radiographic score [1.26 (95% CI − 0.72 to 3.23, p < 0.0001)]. Conclusion: AATPF is a promising treatment of lateral tibial plateau fractures with some advantages over the traditional ORIF. Level of evidence: Therapeutic Level III.