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Joint Diseases and
Related Surgery
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Original Article · Open access

A comparative analysis of arthroscopy-assisted minimally invasive percutaneous plate osteosynthesis versus open reduction and internal fixation for tibial plateau fractures

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Bing Yan

Department of Orthopedics, Leshan People’s Hospital, Leshan, Sichuan, PR China

ORCID: 0009-0001-8096-5165

Jian Zhang

Department of Orthopedics, Leshan People’s Hospital, Leshan, Sichuan, PR China

ORCID: 0009-0000-4036-160X

Wang Yao

Department of Orthopedics, Leshan People’s Hospital, Leshan, Sichuan, PR China

ORCID: 0000-0002-4861-4429

Yu-jie Li

Department of Orthopedics, Leshan People’s Hospital, Leshan, Sichuan, PR China

ORCID: 0009-0003-4084-1568

Abstract

Objectives: This study aims to investigate whether arthroscopy-assisted minimally invasive percutaneous plate osteosynthesis (MIPPO) provided more favorable early functional recovery and reduced surgical trauma compared to traditional open reduction and internal fixation (ORIF).

Patients and methods: A total of 84 patients with Schatzker type I-IV tibial plateau fractures treated between January 2021 and January 2024 were retrospectively analyzed. The MIPPO group (n = 41) underwent arthroscopy-assisted reduction plus MIPPO, while the ORIF group (n = 43) received conventional ORIF. Allocation was chronological, with ORIF predominant in the first two years and MIPPO in the latter two years. Operative parameters, postoperative drainage, radiographic outcomes (Rasmussen radiological score), functional recovery (Hospital for Special Surgery [HSS] score), range of motion (ROM), fracture healing time, hospital stay, and complications were compared.

Results: Of a total of 84 patients, 28 were male and 56 were female of 49.4 ± 9.0 (range, 27 to 69) years. The arthroscopy-assisted MIPPO group had significantly longer operative time (96.0 ± 18.2 vs. 84.0 ± 13.9 min, p = 0.001) but shorter incision length (3.9 ± 0.7 vs. 6.2 ± 0.9 cm, p < 0.001), less intraoperative blood loss (56.5 ± 9.6 vs. 72.6 ± 10.1 mL, p < 0.001), and lower postoperative drainage volume (47.1 ± 7.5 vs. 59.0 ± 7.0 mL, p < 0.001) than the ORIF group. The arthroscopy-assisted MIPPO group also achieved higher Rasmussen radiological scores (15.4 ± 1.4 vs. 14.0 ± 1.6, p < 0.001) and better HSS scores at one, three, and six months postoperatively (all p < 0.001). At six months postoperatively, the MIPPO group also demonstrated significantly improved knee ROM (118.5° ± 8.2° vs. 107.3° ± 9.1°, p < 0.001), a difference exceeding the clinically meaningful threshold for activities of daily living. However, no significant differences were found in hospital stay (p = 0.051), fracture healing time (11.4 ± 1.3 vs. 11.1 ± 1.3 weeks, p = 0.340), or the excellent-and-good rate of HSS score at final follow-up (95.1% vs. 97.7%, p = 0.746). Complication rates were similar between the groups (p = 1.000).

Conclusion: For Schatzker type I-IV tibial plateau fractures, arthroscopy-assisted MIPPO provides more favorable early functional recovery and radiological reduction quality compared to conventional ORIF, with less surgical trauma and comparable early functional recovery and similar complication rates during follow-up. Although operative time is longer, this minimally invasive approach is a safe and effective option for managing these complex fractures. Its principal advantage is accelerated early recovery, particularly in knee ROM, enabling patients to reach clinically meaningful thresholds for activities of daily living sooner.

Declarations

Author Contributions

B.Y.: Conception and design, drafting of the article; J.Z.: Collection and assembly of data, statistical expertise; W.Y.: Analysis and interpretation of the data; Y.J.L.: Critical revision of the article for important intellectual content. All authors read and approved the final manuscript.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

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