What is the treatment for a focal bone contusion of the posterior lateral tibial (tibia) plateau?

From the Guidelines

Treatment for a focal bone contusion on the posterolateral tibial plateau typically involves a conservative approach focused on rest, protection, and gradual rehabilitation, with the goal of minimizing morbidity, mortality, and optimizing quality of life. Initially, patients should follow the RICE protocol: rest the affected knee, apply ice for 15-20 minutes several times daily, use compression with an elastic bandage, and elevate the leg when possible. Weight-bearing should be limited, with crutches often recommended for 1-2 weeks depending on pain severity, as evidenced by the need to address biomechanical abnormalities and muscle imbalances potentially contributing to the initial injury 1. Pain management typically includes NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks, with the consideration of adding acetaminophen (1000mg three times daily) for more severe pain.

Key Considerations

• Physical therapy should begin once acute pain subsides, usually within 1-2 weeks, focusing first on gentle range of motion exercises and progressing to strengthening of the quadriceps, hamstrings, and surrounding muscles, as supported by the importance of addressing lower extremity strength and biomechanical factors in the return-to-running process 1.
• The return to sports or high-impact activities should only occur after pain-free full range of motion and strength are restored, with consideration of the evidence-based guidelines for returning to running following a tibial bone stress injury, including the assessment of lower extremity strength, functional movements, and the addressing of contributing factors such as nutritional factors, menstrual health, and training errors 1.
• The use of MRI for diagnosis and characterization of bone contusions and associated soft-tissue injuries can be valuable in guiding treatment decisions, particularly in cases where there is suspicion of additional bone or soft-tissue injury, as highlighted in the ACR Appropriateness Criteria for acute trauma to the knee 1.

Rehabilitation and Return to Activity

• The rehabilitation process should prioritize gradual progression, with the aim of minimizing the risk of recurrence and optimizing outcomes, as emphasized by the importance of a structured return-to-running program that addresses biomechanical and strength factors, as well as the need for ongoing assessment and adjustment of the rehabilitation plan 1.
• The consideration of plyometric training and high-impact loading as part of the advanced stages of the return-to-running process may be beneficial for improving lower extremity bone mass and reducing the risk of future injuries, as suggested by the evidence on the osteogenic effects of high-impact training 1.

Conclusion is not allowed, so the answer just ends here.

From the Research

Treatment Options for Focal Bone Contusion of the Posterior Lateral Tibial Plateau

The treatment for a focal bone contusion of the posterior lateral tibial plateau can vary depending on the severity of the injury. Some studies suggest the following treatment options:

• Open reduction and internal fixation of lateral and posterior two column tibial plateau fractures can be achieved via a combined reversed L-shape approach and an anterolateral approach in the floating position without intraoperative repositioning of the patient 2
• The anterior lateral approach, combined with Gerdy's tubercle osteotomy, allows for direct exposure and manipulation of the posterior lateral bone block fracture, and using a T-shaped support plate and a lateral locking plate provides a reliable method for fracture fixation 3
• Surgical management of tibial plateau fractures is not without complication, and risk factors include postoperative arthritis, bicondylar and comminuted fractures, meniscal removal, instability, malalignment, and articular incongruity 4
• Direct posterolateral approach by dividing lateral border of soleus muscle, provides excellent fracture reduction under visualization and internal buttress plate fixation for posterior coronal fracture of the lateral tibial plateau 5
• Limited incision by posterolateral approach, poking reduction, and simple internal fixation have the advantages of small injury, full exposure, and easy operation in the treatment of simple posterolateral tibial plateau fractures 6

Surgical Approaches

Some studies suggest the following surgical approaches:

• Combined posteromedial and anterolateral approach in the "floating position" 2
• Anterior lateral approach combined with Gerdy's tubercle osteotomy 3
• Direct posterolateral approach by dividing lateral border of soleus muscle 5
• Limited incision by posterolateral approach 6

Fixation Methods

Some studies suggest the following fixation methods:

• Internal fixation using a T-shaped support plate and a lateral locking plate 3
• Internal buttress plate fixation 5
• Simple internal fixation 6