From the Guidelines
Lateral knee pain after a grade one tibial plateau fracture is most likely caused by meniscal tears, ligament injuries, or occult fractures that were not visible on initial radiographs, and an MRI is recommended for further evaluation 1. The causes of lateral knee pain after such an injury can be multifaceted, including:
- Meniscal tears that may have occurred during the initial injury
- Ligament injuries, particularly to the lateral collateral ligament
- Occult fractures that were not visible on initial radiographs
- Bone marrow contusions and internal derangements of the knee These causes can be accurately identified using MRI, which has superb contrast resolution and multiplanar imaging capability, making it a highly accurate imaging modality in the evaluation of bone marrow contusions, occult fractures, meniscal, and ligamentous injuries 1. Treatment and management of lateral knee pain after a grade one tibial plateau fracture should prioritize reducing inflammation, restoring strength and mobility, and addressing any underlying structural issues.
- Physical therapy focusing on quadriceps and hamstring strengthening
- Pain management with NSAIDs, such as ibuprofen or naproxen, for a short period
- Ice application for pain relief Further evaluation with imaging studies, such as MRI, may be necessary if pain persists beyond 3-6 months post-injury to identify specific causes that might require more targeted interventions 1.
From the Research
Causes of Lateral Knee Pain after Tibial Plateau Grade One Fracture
- Lateral knee pain after a tibial plateau grade one fracture can be caused by various factors, including:
- Meniscus and ligament injuries, as evidenced by studies that found a high prevalence of internal derangement of the knee in patients with tibial plateau fractures 2, 3
- Soft tissue injuries, which are common in high-energy tibial plateau fractures and can be assessed using the Tscherne classification system 2
- Nerve injuries, compartment syndrome, and wound problems, which can occur in high-energy fractures and are associated with higher Tscherne classification grades 2
- Post-traumatic arthritis, which can develop after a tibial plateau fracture and cause chronic knee pain 4, 5
- The Schatzker classification system is commonly used to classify tibial plateau fractures, and studies have found that higher Schatzker classification grades are associated with more severe injuries and worse outcomes 2, 4, 5
- MRI can be a helpful tool in evaluating the extent of injuries in patients with tibial plateau fractures, including meniscus and ligament injuries, and can aid in the accurate characterization of fracture patterns and severity 2, 3
- Patient-reported outcomes, such as pain and functional assessment, can continue to improve over time after a tibial plateau fracture, at least in a statistical sense, if not also clinically 5