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Additional info for AANA Advanced Arthroscopy. The Knee
Arthroscopy. 2004;20:1063-1070. Lubowitz, J, Elson, W, Guttmann, D. Part II: Arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fracture. Arthroscopy. 2005;21:86-92. Chan Y, Chiu, C, Lo Y, et al. Arthroscopy-assisted surgery for tibial plateau fractures: 2- to 10-year follow-up results. Arthroscopy. 2008;24: 760-768. Chapter 3 Arthroscopic Management of Tibial Plateau Fractures 4. 5. 6. 7. 8. 9. Burnstein DB, Viola A, Fulkerson JP. Entrapment of the medial meniscus in a fracture of the tibial eminence.
The fracture is reduced. Fibrous tissue or clot must be removed from the fracture bed. Entrapped meniscal tissue is retracted and dislodged. A 90-degree suture lasso may be placed percutaneously (or via an accessory portal) through the fibers of the ACL in its midcoronal plane and as close to the bony fragment (distally) as possible. The wire loop within the lasso is secured with an arthroscopic grasper (Fig. 3-9) and pulled via a cannula through either of the portals and loaded with a no. 2 high-strength suture.
Debate has ensued over anatomic reduction versus overreduction. 15-17 More studies are needed to answer the question of anatomic versus overreduction, but there is consensus that any displacement requires at least an anatomic reduction. Management has been based on the Meyers and McKeever classification, with recommendations for immobilization in extension for type I fractures. Some controversy exists in regard to what degree the knee is to be extended for nonoperative management. 19 These authors favor immobilization in full extension to avoid a flexion contracture, which can occur if the knee is kept in a flexed position.