Management of a Rare Combined Osseoligamentous Knee Injury: Tibial Plateau Fracture with High-Grade Posterior Cruciate Ligament Tear Treated by Arthroscopic Reconstruction and Osteosynthesis - A Case Report.

INTRODUCTION

Tibial plateau fractures (TPFs) are intra-articular injuries accounting for approximately 1% of all fractures and are frequently associated with soft-tissue and ligamentous injuries. Medial condyle fractures (Schatzker type IV) are uncommon but often result in instability, particularly when associated with posterior cruciate ligament (PCL) injury. Such combined injuries are complex and may be underdiagnosed, especially following delayed presentation. We report a rare case of a medial TPF with high-grade PCL injury managed using a combined arthroscopic and open surgical approach.

CASE REPORT: An 18-year-old male presented 45 days after a high-velocity motorbike accident with persistent knee pain, swelling, and instability following initial native bandaging therapy. Clinical examination and imaging, including radiographs and magnetic resonance imaging (MRI), were performed. A single-stage surgical management comprising arthroscopic PCL reconstruction and open reduction and internal fixation (ORIF) of the tibial plateau was undertaken.

RESULTS

Radiographs demonstrated a depressed medial TPF (Schatzker type IV) with fibular head fracture. MRI revealed a high-grade PCL tear with posterior tibial translation and no other ligamentous injury. Arthroscopic PCL reconstruction was performed using a quadrupled hamstring graft, followed by ORIF of the medial tibial plateau with a locking compression plate and corrective osteotomy. Post-operatively, the patient underwent staged rehabilitation. At 10th month follow-up, he achieved a knee range of motion of 0-110° with no residual instability or complications.

CONCLUSION

This case highlights the importance of early MRI evaluation in TPFs to detect associated ligamentous injuries. A combined arthroscopic and open surgical approach enables simultaneous restoration of ligamentous stability and articular congruity, leading to favorable functional outcomes even in delayed presentations.