Modified Rasmussen Radiological Score for Tibial Plateau Fractures
Primary Role and Application
The Modified Rasmussen Radiological Score is a validated outcome measure used to assess the quality of fracture reduction immediately post-operatively and at follow-up in tibial plateau fractures, with scores ranging from 10-18 points where higher scores indicate better anatomic reduction. 1, 2, 3
Scoring System and Interpretation
The Rasmussen radiological score evaluates anatomic reduction quality on a scale of 10-18 points, with excellent outcomes typically scoring 16-18 points, good outcomes 14-15 points, and unacceptable outcomes below 14 points 1, 2, 3
The score assesses key radiographic parameters including articular surface congruity, condylar widening, and tibial plateau angle (TPA) maintenance 1, 3
Anatomic reduction is defined as restoration with less than 2mm articular step-off, which correlates with higher Rasmussen scores (14-18 points) 1
Clinical Application in Treatment Assessment
The score serves as an immediate post-operative quality metric—studies demonstrate mean scores of 14.1-17.0 points across different surgical approaches (ARIF vs ORIF vs MIPO), indicating the score's utility in comparing surgical techniques 1, 2, 3
Serial radiographic assessment using this score at 1.5,3,6, and 12 months post-operatively helps detect loss of reduction, particularly monitoring TPA and posterior slope angle stability 1
The radiological score should be used in conjunction with the Modified Rasmussen Functional Score (clinical assessment) to provide comprehensive outcome evaluation, as radiographic and functional outcomes may diverge 2, 3, 4
Integration with Modern Imaging Protocols
While the Rasmussen score uses plain radiographs, CT imaging should be obtained first for surgical planning, as CT demonstrates 100% sensitivity for detecting tibial plateau fractures compared to 83% for radiographs alone and provides critical information about articular surface depression 5
CT-detected articular depression >11mm predicts higher risk of lateral meniscus tears and ACL avulsion fractures, which impacts surgical planning beyond what the Rasmussen score captures 5, 6
MRI should be added after CT when articular depression exceeds 11mm, when clinical suspicion exists for meniscal or ligamentous injury, or when surgical planning requires evaluation of bone marrow contusions 5
Prognostic Value and Limitations
Higher Rasmussen radiological scores (excellent/good range) correlate with better functional outcomes, with studies showing 71-93% excellent-to-good rates when anatomic reduction is achieved 1, 3
Age significantly impacts outcomes—patients aged 45 years or younger achieve acceptable anatomic outcomes in 71-73% of cases, while those over 60 years have 67-75% unacceptable outcomes despite similar Rasmussen scores (p=0.001) 3
The score has limitations in detecting soft tissue injuries—arthroscopically assisted procedures reveal meniscal lesions in significant numbers of patients despite acceptable radiological scores, highlighting that the Rasmussen score alone is insufficient for complete injury assessment 2
Practical Implementation Algorithm
Obtain immediate post-operative radiographs and calculate Rasmussen radiological score to document reduction quality 1, 2, 3
Target scores of 14 or higher (good-to-excellent range) as this threshold correlates with acceptable functional outcomes 1, 2, 3
Perform serial radiographic assessments at 1.5,3,6, and 12 months, recalculating the score to detect any loss of reduction requiring intervention 1
Combine radiological scoring with functional assessment (Modified Rasmussen Functional Score) at 12-month follow-up for comprehensive outcome evaluation 2, 3, 4
Critical Pitfalls to Avoid
Do not rely solely on the Rasmussen radiological score for treatment decisions—it assesses only bony alignment and misses 17% of fractures that CT detects, plus all soft tissue injuries 5, 2
Do not skip CT imaging in favor of plain radiographs alone, as CT is essential for detecting articular depression and predicting associated soft tissue injuries that impact management 5
Recognize that acceptable Rasmussen scores do not exclude meniscal tears or ligamentous injuries—maintain high clinical suspicion and obtain MRI when indicated by CT findings (depression >11mm) or clinical examination 5, 6, 2