Knee Stiffness After Tibial Plateau Fractures: Predictors and Outcomes (OTA-41).

OBJECTIVES: What patient characteristics and injury factors predict decreased knee range of motion (ROM) after operative management of tibial plateau fractures?

DESIGN: Prospective cohort study.

SETTING: Academic medical center.

PATIENTS: Over 11 years, tibial plateau fractures at a single academic institution were prospectively followed. A total of 266 patients were included in this study.

INTERVENTION: Surgical repair of tibial plateau fractures and secondary interventions due to arthrofibrosis.

MAIN OUTCOME MEASURE: Clinical outcomes were evaluated using the Short Musculoskeletal Function Assessment and ROM at 3-month, 6-month, and long-term follow-up. Secondary outcomes were considered as the need for a subsequent procedure due to arthrofibrosis.

RESULTS: At 3-month follow-up, the mean ROM was 113 degrees. By long-term follow-up (mean = 17 months), the mean ROM improved to 125 degrees. Independent predictors of decreased knee ROM were the following: at 3-month follow-up, open fractures (P = 0.047), application of a knee-spanning external fixator (P = 0.026), orthopaedic polytrauma (P = 0.003), and tibial spine involvement (P = 0.043); and at long-term follow-up, nonwhite ethnicity (P = 0.003), increasing age (P = 0.003), and a deep infection (P = 0.002). Ten patients (3.7%) required a secondary procedure for arthrofibrosis. There was a significant improvement in the knee ROM (P < 0.001) and functional outcomes (P = 0.004) following the intervention.

CONCLUSIONS: At long-term follow-up, independent predictors of decreased knee ROM were nonwhite ethnicity, increasing age, and sustaining a postoperative complication of a deep infection. Secondary interventions were reliable treatments for arthrofibrosis.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.