Anterolateral Approach With Lateral Epicondyle Osteotomy in Tibial Plateau Fractures: Functional and Radiological Results at 6-Month Follow-Up
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Published:
Dec 27, 2025
Keywords:
Knee, tibial plateau fractures, surgical approach, lateral femoral epicondyle osteotomy
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Abstract
Introduction: In tibial plateau fractures, achieving anatomical reduction of the articular surface is essential, and adequate visu-alization through an appropriate approach is indispensable to accomplish this. The aim of this study is to describe the surgical technique of the anterolateral approach with lateral epicondyle osteotomy and to report the functional and radiological outcomes in a series of patients with a minimum follow-up of 6 months.
Materials and Methods: Over a 24-month period, nine anterolateral ap-proaches with lateral epicondyle osteotomy were performed in five women and four men (mean age 40.1 years; range 18-62) pre-senting with lateral tibial plateau fractures involving the posterior sector. The mean follow-up was 13 months (range 6-24).
Results: Radiographic assessment included evaluation of bone healing and comparison of condylar width, medial proximal tibial angle, and tibial slope with the contralateral knee. All fractures consolidated radiographically. No cases of nonunion or displacement of the osteotomy bone block were observed. Clinical and functional outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Rasmussen score. Outcomes were good to excellent in all cases, with a mean KOOS score of 82.
Conclusion: The anterolateral approach with lateral epicondyle osteotomy provides excellent visualization of the posterior aspect of the lateral tibial plateau, facilitating anatomical reduction of articular fragments. It is a valid and reproducible option that does not require special patient positioning and minimizes the risk of neurovascular injury.
Materials and Methods: Over a 24-month period, nine anterolateral ap-proaches with lateral epicondyle osteotomy were performed in five women and four men (mean age 40.1 years; range 18-62) pre-senting with lateral tibial plateau fractures involving the posterior sector. The mean follow-up was 13 months (range 6-24).
Results: Radiographic assessment included evaluation of bone healing and comparison of condylar width, medial proximal tibial angle, and tibial slope with the contralateral knee. All fractures consolidated radiographically. No cases of nonunion or displacement of the osteotomy bone block were observed. Clinical and functional outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Rasmussen score. Outcomes were good to excellent in all cases, with a mean KOOS score of 82.
Conclusion: The anterolateral approach with lateral epicondyle osteotomy provides excellent visualization of the posterior aspect of the lateral tibial plateau, facilitating anatomical reduction of articular fragments. It is a valid and reproducible option that does not require special patient positioning and minimizes the risk of neurovascular injury.
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Ciccarello, V. A., Aranibar, I., Romagnoli, M. E., Blanco O´DenaG. J., & Espinoza Mendoza, D. (2025). Anterolateral Approach With Lateral Epicondyle Osteotomy in Tibial Plateau Fractures: Functional and Radiological Results at 6-Month Follow-Up. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(6), 514-524. https://doi.org/10.15417/issn.1852-7434.2025.90.6.2142
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Clinical Research
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References
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13. Beatti MA, Zublin Guerra CM, Guichet DM, Pellecchia TS. Abordaje intergemelar posteromediano del platillo tibial. Descripción de la técnica quirúrgica. Rev Asoc Argent Ortop Traumatol 2022;87(2):273-84. https://doi.org/10.15417/issn.1852-7434.2022.87.2.1437
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20. Lysholm J, Briggs KK, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 2009;37(5):890-7. https://doi.org/10.1177/0363546508330143
21. Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 1998;80(1):63-9. https://doi.org/10.1302/0301-620x.80b1.7859
22. Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN. The new Knee Society Knee Scoring System. Clin Orthop Relat Res 2012;470(1):3-19. https://doi.org/10.1007/s11999-011-2135-0
23. Van Dreumel RL, van Wunnik BP, Janssen L, Simons PC, Janzing HM. Mid- to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures. Injury 2015;46(8):1608-12. https://doi.org/10.1016/j.injury.2015.05.035
outcome after surgical reconstruction of OTA type B and C tibial plateau fractures: how crucial is the restoration of articular congruity? Arch Orthop Trauma Surg 2023;143(4):1973-80. https://doi.org/10.1007/s00402-022-04405-5
2. Schatzker J, Kfuri M. Revisiting the management of tibial plateau fractures. Injury 2022;53(6):2207-18. https://doi.org/10.1016/j.injury.2022.04.006
3. Krause M, Frings J, Hüseyin I, Frosch K-H. Comparison of extended lateral approaches to the tibial plateau: the articular exposure of lateral epicondyle osteotomy with and without popliteus tendon vs. fibula osteotomy. Injury 2020;51:1874-8. https://doi.org/10.1016/j.injury.2020.05.038
4. Krause M, Krüger S, Müller G, Püschel K, Frosch K-H. How can the articular surface of the tibial plateau be best exposed? A comparison of specific surgical approaches. Arch Orthop Trauma Surg 2019;139(10):1369-77. https://doi.org/10.1007/s00402-019-03200-z
5. Frosch K-H, Korthaus A, Thiesen D, Frings J, Krause M. The concept of direct approach to lateral tibial plateau fractures and stepwise extension as needed. Eur J Trauma Emerg Surg 2020;46:1211-9. https://doi.org/10.1007/s00068-020-01422-0
6. Kfuri M, Schatzker J, Teixeira Castiglia M, Giordano V, Fogagnolo F, Stannard JP. Extended anterolateral approach for complex lateral tibial plateau fractures. J Knee Surg 2017;30(3):204-11. https://doi.org/10.1055/s-0037-1598077
7. Kfuri M, Schatzker J. Revisiting the Schatzker classification of tibial plateau fractures. Injury 2018;49(12):2252-63. https://doi.org/10.1016/j.injury.2018.11.010
8. Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth 2011;55:111-5. https://doi.org/10.4103/0019-5049.79879
9. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS) -- development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998;28(2):88-96. https://doi.org/10.2519/jospt.1998.28.2.88
10. Rasmussen P. Tibial condylar fractures impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am 1973;55(7):1331-50. PMID: 4586086
11. Meulenkamp B, Martin R, Desy NM, Duffy P, Korley R, Puloski S, et al. Incidence, risk factors, and location of articular malreductions of the tibial plateau. J Orthop Trauma 2017;31(3):146-50. https://doi.org/10.1097/BOT.0000000000000735
12. Luo C-F, Sun H, Zhang B, Zeng B-F. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 2010;24(11):683-92. https://doi.org/10.1097/BOT.0b013e3181d436f3
13. Beatti MA, Zublin Guerra CM, Guichet DM, Pellecchia TS. Abordaje intergemelar posteromediano del platillo tibial. Descripción de la técnica quirúrgica. Rev Asoc Argent Ortop Traumatol 2022;87(2):273-84. https://doi.org/10.15417/issn.1852-7434.2022.87.2.1437
14. Lobenhoffer P, Gerich T, Bertram T, Lattermann C, Pohlemann T, Tscheme H. Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures. Unfallchirurg 1997;100(12):957-67. [En alemán] https://doi.org/10.1007/s001130050218
15. Carlson DA. Bicondylar fracture of the posterior aspect of the tibial plateau. A case report and a modified operative approach. J Bone Joint Surg Am 1998;80(7):1049-52. https://doi.org/10.2106/00004623-199807000-00014
16. Frosch KH, Balcarek P, Walde T, Stürmer KM. A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma 2010;24(8):515-20. https://doi.org/10.1097/BOT.0b013e3181e5e17d
17. Brilhault J, Lautman S, Favard L, Burdin P. Lateral femoral sliding osteotomy lateral release in total knee arthroplasty for a fixed valgus deformity. J Bone Joint Surg 2002;84(8):1131-7. https://doi.org/10.1302/0301-620x.84b8.12824
18. Solomon LB, Stevensonm AW, Baird RPV, Pohl AP. Posterolateral transfibular approach to tibial plateau fractures: Technique, results, and rationale. J Orthop Trauma 2010;24:505-14. https://doi.org/10.1097/BOT.0b013e3181ccba4b
19. Cho J-W, Kim J, Cho W-T, Kim J-K, Samal P, Gujjar PH, et al. Approaches and fixation of the posterolateral fracture fragment in tibial plateau fractures: a review with an emphasis on rim plating via modified anterolateral approach. Int Orthop 2017;41(9):1887-97. https://doi.org/10.1007/s00264-017-3563-6
20. Lysholm J, Briggs KK, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 2009;37(5):890-7. https://doi.org/10.1177/0363546508330143
21. Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 1998;80(1):63-9. https://doi.org/10.1302/0301-620x.80b1.7859
22. Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN. The new Knee Society Knee Scoring System. Clin Orthop Relat Res 2012;470(1):3-19. https://doi.org/10.1007/s11999-011-2135-0
23. Van Dreumel RL, van Wunnik BP, Janssen L, Simons PC, Janzing HM. Mid- to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures. Injury 2015;46(8):1608-12. https://doi.org/10.1016/j.injury.2015.05.035