Radiological Outcomes: ArIF vs ORIF for Tibial Plateau Fractures
Arthroscopically-assisted reduction and internal fixation (ArIF) produces superior radiological outcomes compared to open reduction and internal fixation (ORIF) for Schatzker type I-IV tibial plateau fractures, with significantly better Rasmussen radiographic scores.
Key Radiological Findings
ArIF Demonstrates Better Radiographic Results
ArIF achieves statistically superior radiological outcomes with a mean Rasmussen radiographic score of 14.9 compared to 14.1 for ORIF (p < 0.05) in Schatzker I-IV fractures 1
A larger comparative study found ArIF produced better modified Rasmussen radiological scores (8.42 ± 2.24) versus ORIF (7.33 ± 1.83) for lateral plateau fractures (Schatzker I-III), though this did not reach statistical significance (p = 0.104) 2
Another study reported ArIF radiographic scores of 16.56 ± 2.66 compared to ORIF scores of 15.88 ± 2.71, demonstrating consistent trends favoring arthroscopic assistance 3
Fracture-Type Specific Considerations
For Schatzker type I fractures, there are no radiological differences between ArIF and ORIF techniques 3
ArIF shows the most pronounced radiological advantage in Schatzker type II-IV fractures, where arthroscopic visualization allows more precise articular surface restoration 3
For complex fractures (Schatzker V-VI), both techniques yield poor medium- and long-term radiological results, though ArIF may still be preferable due to lower infection rates 3
Imaging Assessment Framework
Preoperative Radiological Evaluation
CT imaging is mandatory for surgical planning, demonstrating 100% sensitivity for tibial plateau fractures compared to 83% for plain radiographs alone 4
The amount of articular surface depression on CT predicts associated soft tissue injuries—specifically, depression >11 mm indicates higher risk of lateral meniscus tear and ACL avulsion fracture 4, 5
MRI should be obtained when CT shows significant articular depression (>11 mm), as it provides superior evaluation of meniscal and ligamentous injuries that may require concurrent treatment 4, 5
Postoperative Radiological Monitoring
Standard 3-view radiographs of the knee should be obtained for initial postoperative assessment 4
CT-reconstructed images enhance morphological assessment and can identify subtle loss of reduction or hardware complications 4
Clinical Correlation with Radiological Outcomes
Functional Outcomes Mirror Radiological Success
Despite superior radiological scores with ArIF, clinical outcomes (KSS and Rasmussen clinical scores) show no significant differences between techniques in most studies 1
However, one study demonstrated significantly better KSS scores with ArIF (92.37 ± 6.3) versus ORIF (86.29 ± 11.54, p < 0.05), suggesting radiological precision may translate to functional benefit 2
Post-Traumatic Osteoarthritis
Radiographic osteoarthritis rates show no statistically significant differences between ArIF and ORIF in lateral plateau fractures 2
The need for total knee arthroplasty does not differ between treatment modalities despite radiological variations 6
Important Caveats
Associated Soft Tissue Injuries
Meniscal lesions are identified in 42.5-60% of patients during ArIF, representing injuries that would be missed with ORIF alone 1, 2
Concomitant intra-articular soft tissue lesions correlate with worse clinical and radiological results regardless of fixation technique (p < 0.05) 2
The ability to address these lesions during ArIF may explain the superior radiological outcomes, as untreated meniscal pathology can lead to progressive joint degeneration 3
Technical Limitations
ArIF requires specialized arthroscopic skills and equipment that may not be universally available 1, 3
The radiological advantage of ArIF diminishes in very simple (Schatzker I) or very complex (Schatzker V-VI) fracture patterns 3
One study reported inability to achieve adequate arthroscopic reduction in one case, requiring conversion to open arthrotomy, which resulted in the only poor outcome 7