The Midline Lateral Parapatellar Arthrotomy: A Safe Alternative Approach for Lateral Tibial Plateau Fractures

OBJECTIVES: The midline lateral parapatellar (LP) approach has been shown in a cadaveric study to provide superior articular exposure compared to the anterolateral approach (AL). The purpose of this study was to report on outcomes and complications with the LP approach. METHODS: Design: Retrospective comparative cohort study and prospective cohort Setting: Academic Level-I trauma center Patient Selection Criteria: Adult patients with minimum 3 months follow up who underwent open reduction internal fixation (ORIF) of an acute, isolated lateral tibial plateau fracture (OTA/AO 41-B1, 41-B2, 41-B3) via a LP arthrotomy or AL submeniscal arthrotomy between 2010-2019. Outcome Measures and Comparisons: Retrospective cohort evaluated using postoperative complications including infection, delayed wound healing, and reoperation rate. Prospective cohort evaluated using Short Musculoskeletal Function Assessment (SMFA), knee range of motion (ROM), and complications. RESULTS: The mean age for the LP cohort was 41.5 years (19-79) and 18/32 (56.3%) were male. The mean age for the AL cohort was 42.8 years (18-71) and 29/49 (59.2%) were male. The mean age for patients in the prospective study was 31.4 years (19-59) and 9/14 (64.3%) were male. Mean follow-up was 9.3 months and 20.3 months for the retrospective and prospective cohorts respectively. There was no significant difference in complication or reoperation rate (p>0.39). For the prospective cohort mean ROM was 130 degrees. Mean SMFA dysfunction index (DI) was 9.0 and mean bother index (BI) was 11.1. CONCLUSIONS: The lateral parapatellar approach resulted in comparable clinical and functional outcomes to those seen historically with the anterolateral approach. It is a safe alternative and may be of most benefit when treating comminuted lateral tibial plateau fractures. LEVEL OF EVIDENCE: Level III