前交叉韧带重建术止点定位的临床研究

[目的]通过比较不同临床结果下前交叉韧带重建术骨隧道止点位置的差异，探讨理想骨隧道的影像学位置。[方法]选择55例关节镜下前交叉韧带重建术病例，对过伸位X线侧位片测量并分别计算股骨、胫骨止点及Blumensaat线的胫骨平台投影点相对位置。根据临床结果不同分两组对上述资料分析影像表现差别。[结果]股骨侧止点位置在不同临床结果的两组间有显著性差异，胫骨止点位置和Blumensaat线投影点位置组间无差异性。胫骨止点均位于Blumensaat线投影点之后。[结论]股骨侧止点位置偏前临床效果较差，大致位于Blumensaat线距股骨外侧髁前缘交点的65％-69％之间。胫骨侧止点在伸直位Blumensaat线胫骨投影点之后，大致位于胫骨平台前后直径距前缘38％-41％之间。术前进行患膝关节的过伸位X线片检查，并测量Blumensaat线的胫骨投影位置，有助于为术前胫骨止点定位提供参考。     

关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉与前交叉韧带

目的 评价关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带的临床疗效.方法 14例前、后交叉韧带损伤患者在关节镜下应用异体跟腱同时重建前、后交叉韧带,且后交叉韧带股骨侧应用双束双隧道重建.受伤至手术时间平均19.5 d.术后平均随访34.5个月.采用Lysholm评分和Tegner评分对患膝功能进行评估,通过KT-1000检查膝关节的前后松弛度.术前患者屈膝活动度(123.6±2.5)°,Lysholm评分(52.8±2.2)分,伤前Tegner评分平均为(5.9±0.5)分,术前为(1.2±0.9)分.结果 术后患者屈膝活动度(117.9±2.8)°,与术前比较差异无统计学意义(t=1.54,P=0.14).术后Lachman试验阴性者13例(92.9%),后抽屉试验阴性者12例(85.7%).KT-1000屈膝25°双侧胫骨前后松弛度差值在2 mm以内9例,3～5 mm 4例,6 mm1例.屈膝70°差值2 mm以内10例,3～5 mm 3例,6 mm 1例.Lysholm评分术后提高至(92.9±3.3)分,差异具有统计学意义(t=17.009,P＜0.001).术后Tegner评分终末随访时平均为(5.4±0.8)分.手术前后的差异有统计学意义(F=4.2,P＜0.01).11例恢复到受伤前运动水平(78.6%),另外3例运动水平较受伤前有所降低.结论 关节镜下应用异体跟腱股骨双束双隧道同时重建后交叉韧带与前交叉韧带,后交叉韧带股骨侧应用双束双隧道重建,更接近后交叉韧带解剖重建,能够恢复膝关节的稳定性,较满意地恢复膝关节功能.     

关节镜下自体双束半腱肌股薄肌腱重建后交叉韧带

目的关节镜下应用自体半腱肌腱、股薄肌腱双束股骨双隧道重建膝后交叉韧带(PCL),并探讨其近期临床效果。方法采用自体半腱肌腱、股薄肌腱双束股骨双隧道重建膝后交叉韧带29例。结果随访时间12～26个月,平均16个月。本组29例术后PDT试验(-)9例,( )19例,( )1例;IKDC评分正常9例,接近正常17例,不正常3例;Lysholm评分:优20例,良6例,中3例。膝关节伸直受限2例,均小于10°。膝关节屈曲活动正常者20例,5例屈曲受限小于10°,3例小于20°,1例30°。术前屈膝30°和90°时KT-2000测定胫骨后移分别为(13.2±2.8)mm和(13.9±3.2)mm,术后分别为(4.0±0.4)mm和(4.4±0.5)mm,术前、术后二者比较有显著性差异(P<0.01)。结论关节镜下应用自体半腱股薄肌腱双束重建后交叉韧带更加符合PCL的解剖重建和生理学功能,稳定性好,疗效肯定。     

胫骨平台内后髁合并前交叉韧带胫骨止点骨折的手术治疗

目的 探讨胫骨平台内后髁合并前交叉韧带胫骨止点骨折的损伤机制和手术治疗.方法 收治胫骨平台内后髁合并前交叉韧带胫骨止点骨折11例.采用改良膝关节后内切口,切开复位支撑钢板内固定.结果 随访8～18个月,骨折均愈合.术后1年膝关节伸直-5～5°.平均-2°;屈曲90°～135°,平均119°,1例残留Ⅰ度前抽屉试验阳性.HSS评分平均为91.6分.结论 胫骨平台内后髁骨折与前交叉韧带胫骨止点骨折有较高关联性,手术治疗疗效优良.     

关节镜下LARS人工韧带重建后交叉韧带

目的 探讨在关节镜下应用韧带增强重建系统(ligament advanced reinforcement system,LARS)人工韧带重建膝关节后交叉韧带的手术方法和临床疗效. 方法 2006年6月-2007年7月,应用LARS人工韧带在关节镜下重建9例膝关节后交叉韧带断裂患者.男8例,女1例;年龄23～49岁.左膝3例,右膝6例.致伤原因:运动扭伤5例,摔伤1例,车祸伤3例.伤后至手术时间6～20 d,平均13.6 d.合并内侧半月板损伤2例,外侧半月板损伤1例.X线片示胫骨平台无撕脱骨折.术前Lysholm膝关节功能评分为40～55分,平均50分:按国际膝关节评分委员会(international kneedocumentation commime,IKDC)评分C级1例,D级8例:反Lachman试验( )l例,( )6例,( )2例.治疗在关节镜下完成,后交叉韧带胫骨止点、隧道用"定位器"完成;股骨止点、隧道在C臂X线机下完成;骨隧道直径为6 mm,LARS人工韧带直径为7 mm. 结果 本组术后切口均1期愈合,无手术相关并发症发生.所有患者均获随访,随访时间8～16个月,平均10.5个月.术后Lysholm评分70～95分,平均85分;优5例,良3例,可1例,优良率为88%.术后IKDC评分A级7例,B级2例;反Lachman试验均为阴性.无术后感染、韧带自发断裂、松动等并发症发生. 结论 运用LARS人工韧带重建膝后交叉韧带可达到解剖重建,有效恢复膝关节稳定性;且关节镜下手术创伤小、康复快、疗效好.     

关节镜下保留残端纤维的前交叉韧带单束解剖重建术

目的:探讨关节镜下保留残端纤维的前交叉韧带单束解剖重建术的方法及临床效果。方法:自2007年10月至2009年11月,对17例前交叉韧带断裂患者进行保留残端纤维的前交叉韧带单束解剖重建术。其中男10例,女7例;年龄28～62岁,平均39.3岁。致伤原因:交通事故9例,日常生活摔倒受伤6例,运动创伤2例。伤后至手术时间平均8.5d(2～14d)。采用国际膝关节文献委员会(IKDC)分级及Lysholm评分等评估患者手术疗效。结果:17例均获随访,时间24～39个月,平均29.5个月。所有患者未发现腘窝动脉、胫神经或腓总神经损伤等并发症。12例膝关节活动度达到正常;1例出现关节僵硬,术后6个月予以关节镜下松解,术后积极功能锻炼,术后膝关节屈曲20°缺失,伸直正常;3例有屈曲5°～10°缺失;1例有5°过伸受限。17例后抽屉试验和Lachman试验均阴性。17例IKDC评分均达到或接近正常。IKDC总评分16例正常,1例接近正常。末次随访时IKDC主观评分为94.3±5.1,Lysholm评分为94.7±3.1。结论:关节镜下保留残端纤维的前交叉韧带单束解剖重建术可获得良好的临床效果。     

关节镜下经后入路保留残留后交叉韧带纤维和板股韧带重建后交叉韧带

目的探讨关节镜下经后入路保留残留后交叉韧带(PCL)纤维和板股韧带重建PCL的临床应用效果。方法对9例患者应用自体腘绳肌腱在关节镜下结合常规入路和后入路保留残留的PCL纤维和板股韧带重建PCL。胫骨隧道定位在PCL胫骨止点外侧关节面下方1～1.5 cm处。股骨隧道经前外侧入路定位于股骨内侧髁关节软骨后方1 cm处。自体肌腱移植物两端用可吸收界面螺钉固定。术后6个月了解膝关节功能恢复情况。结果 9例均随访6个月。患者无伸膝受限;2例10°～15°屈膝受限,1例Ⅰ度后抽屉试验阳性。Ly-sholm膝关节功能评分和IKDC评分较术前均有显著改善(P<0.01)。结论膝关节后入路保留PCL残留纤维和板股韧带重建PCL,镜下视野清楚、无盲区,操作安全,韧带的胫骨止点定位准确,同时符合生物学和生物力学,短期疗效肯定。     

关节镜辅助下应用自体半腱肌腱微创重建膝交叉韧带和加强重建后外侧角韧带

目的探讨膝交叉韧带和后外侧韧带结构损伤的治疗方法 ,评估临床治疗效果。方法 2004年5月～2009年2月,对32例膝交叉韧带合并后外侧韧带结构损伤的患者,在关节镜辅助下应用自体半腱肌腱一期重建交叉韧带和加强重建后外侧角韧带。结果 32例随访1～4年,平均2.3年。所有患者在站立、行走和下楼梯时没有与膝关节后外侧不稳相关的过伸位膝关节不稳感;未发现行走时膝关节内甩者。关节活动度,屈曲110°～130°,平均118°;伸0°～5°。按照IKDC膝关节评分标准,主观评价:正常10例(31%),近似正常16例(50%),不正常6例(19%),无严重异常;客观评价48～95分,平均83分。结论对膝交叉韧带合并后外侧韧带结构损伤,通过应用自体半腱肌腱微创手术重建能够满意恢复膝关节后外侧的稳定性和关节功能。     

锚钉缝线桥技术避骨骺内固定治疗青少年PCL胫骨止点撕脱骨折

目的探讨应用锚钉缝线桥技术避骨骺内固定治疗青少年后交叉韧带(posterior cruciate ligament,PCL)胫骨止点撕脱骨折的临床疗效。方法我院自2014年4月至2017年7月共收治6例后交叉韧带胫骨止点撕脱骨折的青少年患者,其中男4例,女2例;年龄8~17岁,平均(13.0±3.0)岁。均为McKeeverⅢ型骨折,采用膝后内侧入路双排锚钉缝线桥技术避开骨骺固定骨折块,并记录手术时间、术后并发症、骨折愈合情况、末次随访膝关节屈伸活动度及肢体长度,应用Lysholm膝关节评分系统评估膝关节功能,并与健侧进行对比分析。结果6例患者均获随访,随访时间在24~36个月,平均(29.7±4.1)个月。手术时间53~68 min,平均(59.8±5.2)min。手术切口均甲级愈合,无神经血管损伤,所有骨折均愈合良好,愈合时间8~12周,平均(9.33±1.49)周。末次随访时患膝Lysholm评分为94~97分,平均(95.0±1.3)分;关节活动度伸膝-5°~2°,平均(-1.3±2.3)°;屈膝130°~143°,平均(135.5±4.8)°,肢体长度62.8~95.0 cm,平均(82.3±10.9)cm;术后各指标与健侧相比差异均无统计学意义(P>0.05)。结论应用双排锚钉缝线桥技术避开骨骺固定青少年膝后交叉韧带胫骨止点撕脱骨折,可以避免骨骺损伤,固定牢靠,功能恢复好,取得良好的临床疗效。     

关节镜下改良高强线规避骺板固定治疗儿童前交叉韧带下止点撕脱骨折

目的介绍关节镜下改良高强线规避骺板固定治疗儿童前交叉韧带下止点撕脱骨折的手术方法。方法回顾性分析2016年1月至2020年6月我院收治的24例行关节镜下改良高强线规避骺板固定治疗的儿童前交叉韧带下止点撕脱骨折患者的资料,其中男15例,女9例;年龄8～17岁,平均(11.9±2.9)岁;运动损伤17例,交通损伤7例。按Meyers-McKeever分型:Ⅱ型3例,Ⅲ型21例。术后2周、4周、6周定期复查,依据膝关节X线片评估骨折愈合情况,依据膝关节国际膝关节文献委员会(international knee documentation committee, IKDC)及Lysholm评分评价膝关节功能恢复情况。结果 24例患者均手术顺利,随访3～6个月,平均(4.5±1.1)个月。术中出血20～50 mL,平均(32.0±12.8)mL。手术时间40～90 min,平均(59.2±10.0)min。术后无并发症,术后6周骨折均愈合良好,无畸形愈合。Lysholm评分为(97.41±1.31)分,IKDC主观评价为(97.50±1.17)分。结论关节镜下改良高强线规避骺板固定治疗儿童前交叉韧带下止点撕脱骨折疗效可靠,值得临床推广。     

关节镜下三入路与传统前内侧入路重建前交叉韧带股骨骨道的比较及早期疗效分析

目的:研究三入路和传统前内侧技术确立股骨骨道的位置、长度和冠状面角度以及前交叉韧带重建的早期疗效。方法:2018年12月到2019年6月收集36例诊断为单纯前交叉韧带断裂而且接受手术的患者,患者均有明确膝关节扭伤史,共分为两组,其中16例采用三入路技术钻取股骨骨道重建前交叉韧带,其中男11例,女5例,平均年龄(30.13±6.54)岁,受伤时间7~60(30.19±15.78) d;20例采用传统前内侧入路技术钻取股骨骨道重建前交叉韧带,其中男15例,女5例,平均年龄(30.80±8.60)岁,受伤时间7~60(27.35±15.50) d。通过CT三维重建技术评估钻取的股骨骨道,采用膝关节Lysholm评分评估患者膝关节功能。结果:所有患者手术切口术后都达到Ⅰ期愈合,术中均未出现股骨骨道破裂,血管神经损伤、移植物通过困难及静脉血栓等情况。36例患者获得门诊随访,随访时间9~15(12.00±2.83)个月。采用CT三维重建评估两组患者股骨骨道,股骨骨道位置运用四分法描述为,三入路组:股骨外髁的下(27.83±1.97)%,后(25.57±3.20)%;传统入路组:股骨外髁的下(28.38±3.21)%,后(26.23±3.20)%。骨道长度,三入路组:全长(35.20±5.52) mm,粗骨道长(23.20±2.07) mm;传统入路组:全长(34.60±4.26) mm,粗骨道长(22.56±2.50) mm。冠状面角度,三入路组(47.93±5.98)°;传统入路组(41.78±6.62)°。膝关节Lysholm评分,三入路组:术前57.81±6.23;末次随访97.00±2.48;传统入路组:术前57.15±8.76,末次随访97.30±2.68,手术前后差异有统计学意义,组间差异无统计学意义。结论:两种方式所钻取的股骨骨道的位置均在前交叉韧带的解剖止点范围内,三入路法钻取的股骨骨道相对传统前内侧入路法来说冠状面角度较大,形成的骨道长度、两种手术方式的术后早期疗效、手术时间均无差异,但是三入路法的手术视野更宽阔清晰,而且对于术中钻取股骨骨道时需要的屈膝角度要明显小于传统入路技术,降低了手术的难度。     

Femoral tunnel position in chronic anterior cruciate ligament rupture reconstruction: randomized controlled trial comparing anatomic,biomechanical and clinical outcomes

Purpose

The aim of this study was to compare the outcomes between anteromedial (AM) and transtibial (TT) femoral tunnel positioning techniques for the reconstruction of chronic anterior cruciate ligament (ACL) rupture.

Materials and methods

It is a randomized prospective study of 106 patients who underwent ACL reconstruction because of a chronic ACL rupture (55 AMT, 51 TT). Minimum follow-up was 2 years. Demographic, clinical and radiological data, including MRI grafts’ anatomy and biomechanics intraoperative navigation system evaluation, were analyzed. Also, International Knee Documentation Committee score, Tegner Knee score, Lysholm Knee Score, Short-Form Health Survey and 4-point Likert Scale were evaluated.

Results

The AM technique achieves a more anatomic graft than TT technique in both sagittal and coronal plane (6° approximately). Immediate postoperative biomechanical evaluation of the graft showed both techniques significantly improved translational and rotational laxity (p = 0.000). AMT showed superiority only in controlling internal rotation (p = 0.016). Both techniques reported significant improvement in all evaluated score scales, without differences between techniques. Independently of the femoral tunnel positioning technique, patients with cartilage lesion had worse clinical outcomes.

Conclusions

Our findings suggest that AMT achieves a more anatomical and biomechanically accurate graft allowing better control over internal rotation laxity; however, this does not lead to better clinical outcomes if we compare with TT in the reconstruction of chronic ACL rupture. Patients with chronic ACL rupture and cartilage lesion had worse clinical outcomes, independently the femoral tunnel positioning technique.

     

In–out versus out–in technique for ACL reconstruction: a prospective clinical and radiological comparison

Background

Several studies have recently shown better restoration of normal knee kinematics and improvement of rotator knee stability after reconstruction with higher femoral tunnel obliquity. The aim of this study is to evaluate tunnel obliquity, length, and posterior wall blowout in single-bundle anterior cruciate ligament (ACL) reconstruction, comparing the transtibial (TT) technique and the out–in (OI) technique.

Materials and methods

Forty consecutive patients operated on for ACL reconstruction with hamstrings were randomly divided into two groups: group A underwent a TT technique, while group B underwent an OI technique. At mean follow-up of 10 months, clinical results and obliquity, length, and posterior wall blowout of femoral tunnels in sagittal and coronal planes using computed tomography (CT) scan were assessed.

Results

In sagittal plane, femoral tunnel obliquity was 38.6 ± 10.2° in group A and 36.6 ± 11.8° in group B (p = 0.63). In coronal plane, femoral tunnel obliquity was 57.8 ± 5.8° in group A and 35.8 ± 8.2° in group B (p = 0.009). Mean tunnel length was 40.3 ± 1.2 mm in group A and 32.9 ± 2.3 mm in group B (p = 0.01). No cases of posterior wall compromise were observed in any patient of either group. Clinical results were not significantly different between the two groups.

Conclusions

The OI technique provides greater obliquity of the femoral tunnel in coronal plane, along with satisfactory length of the tunnel and lack of posterior wall compromise.

Level of evidence

II, prospective study.

     

由外向内与经胫骨建立股骨隧道保留残迹重建前交叉韧带的病例对照研究

目的:探讨关节镜下由外向内与经胫骨隧道建立股骨隧道保留残迹重建前交叉韧带(ACL)的临床效果。方法:自2005年6月至2012年1月,采用关节镜下保留残迹重建ACL145例,由外向内建立胫骨和股骨隧道88例(由外向内组),男55例,女33例,年龄18～52岁,平均(29.22±7.31)岁;经胫骨隧道建立股骨隧道57例(经胫骨组),男35例,女22例,年龄18～51岁,平均(29.28±8.07)岁。对两组术前、术后早期及随访时的Lysholm、VAS评分及IKDC分级等进行比较。结果:由外向内组手术时间(76.94±10.83)min,经胫骨组(70.35±10.11)min,经胫骨组手术时间短于由外向内组。两组术后早期关节积液反应差异无统计学意义(P=0.065)。随访18～60个月,两组患者的关节稳定性均较术前提高;由外向内组Lysholm评分由术前54.75±10.58,增加至随访时95.80±5.16;经胫骨组Lysholm评分由术前52.51±11.38,增加至随访时94.86±5.50;此外,两组IKDC评级均较术前有显著改善。随访时两组间比较,轴移试验、Lachman试验和前抽屉试验的稳定性差异无统计学意义,Lysholm评分和IKDC评级差异亦无统计学意义。结论:由外向内技术建立股骨隧道具有容易达到解剖位重建、对关节内干扰小的优点,但技术操作较复杂。而经胫骨技术操作方便,手术时间较短。依据实际情况选择相应的任何一种技术方法,均能取得满意的临床效果。     

Radiological evaluation of tunnel position in single bundle anterior cruciate ligament reconstruction in the Indian population and their clinical correlation

BackgroundProper positioning of osseous tunnels during single bundle arthroscopic ACL reconstruction, which gives reproducibly good clinical outcome, is a matter of concern. Little evidence is there correlating tunnel position in arthroscopic ACL reconstruction with their clinical outcome in Indian population. Our aim in this study was to examine if the radiological tunnel-positions were significantly associated to the clinical outcomes.MethodsACL reconstruction was performed in 147 young patients with an isolated ACL tear. They were followed up prospectively for the next two years. Clinical assessment of each patient was done using the International Knee Documentation Committee (IKDC) evaluation form before surgery and at two years later the surgery. At the same time, the radiological assessment was done on standard digital radiographs.ResultsConsidering the anterior and posterior-most points on the Blumensaat's line as 0% and 100% respectively the average position of the femoral tunnel was at 84.8%. Similarly, the tibial tunnel was at 46.8% along the tibial plateau. On the coronal plane the average position of the tibial tunnel was at 45.6% point along the tibial plateau (measured from the medial-most point towards laterally). The mean position of the femoral tunnel in the coronal plane was at 43.2% along the broadest part of the distal femur (measured from the lateral extent). The average inclination angle of the graft measured 19.6° (along the coronal plane).ConclusionIdeal clinical outcome was significantly associated with the placement of the femoral tunnel along the sagittal plane. Placement of the femoral tunnel should not be beyond the 85% mark along the Blumensaat's line from the anterior-most point. No correlation was established between clinical results and any of the remaining radiological parameters described above.     

Evaluation of an operation support system using the femoral anterior tangent line to determine intraoperative femoral component rotation in total knee arthroplasty

BackgroundThe femoral anterior tangent (FAT) line refers to a line parallel to the anterior surface of the distal femur in the axial plane. This study aimed to evaluate the effectiveness of a new operation support system which uses the FAT line to set the femoral component rotational alignment in total knee arthroplasty (TKA).MethodsA total of 170 consecutive knees in 139 patients undergoing primary TKA with the JIGEN (Jig Engaged Three-dimensional (3D) Pre-Operative Planning Software for TKA) operation support system was examined. The JIGEN system creates 3D models of bones using computed tomography data, allowing for surgical simulations such as positioning of implants while calculating positions of the intramedullary alignment rod (IM rod) and surgical jig. We retrospectively analyzed the FAT line angle relative to the surgical epicondylar axis (SEA) on the axis plane perpendicular to the IM rod and evaluated the accuracy of the femoral component alignment after TKA with the 3D measurement system.ResultsThe FAT line was 9.6° ± 3.7° (range, 1.4°–20.4°) internally rotated relative to the SEA. The average absolute error was 1.4° ± 1.1° in the coronal plane, 2.0° ± 1.5° in the sagittal plane, and 1.6° ± 1.3° in the axial plane. The femoral component outliers (i.e., >3° away from the goal alignment) were 7.7% in the coronal plane, 20.6% in the sagittal plane, and 10.3% in the axial plane.ConclusionsOur findings suggest that the FAT line is a reliable and reproducibly identifiable axis for the accurate determination of proper rotational alignment in TKA. An operation support system which uses the FAT line for determining intraoperative femoral component rotation can effectively achieve highly accurate positioning of the femoral component in TKA.     

残端悬吊包绕肌腱移植物重建前交叉韧带

目的:探讨残端悬吊包绕肌腱移植物重建前交叉韧带的价值。方法:2009年6月至2011年6月对76例前交叉韧带损伤的患者采用残端悬吊包绕肌腱移植物重建前交叉韧带治疗。男59例,女17例;年龄15～46岁,平均29岁。其中运动伤32例,训练伤20例,交通事故伤16例,其他损伤8例。受伤至手术时间平均3周(2～5周)。术前前抽屉试验阳性72例,Lachman试验阳性76例,IKDC主观评分45.9±3.6,Lysholm评分54.3±4.5。结果:术后患者切口均Ⅰ期愈合,无相关并发症发生。69例获得随访,时间17～31个月,平均23个月。末次随访Lachman试验均呈阴性;IKDC评级A级36例,B级30例,C级3例,D级0例;IKDC主观评分91.5±3.4,较术前提高;Lysholm评分92.4±3.8,较术前提高。结论:采用残端悬吊包绕肌腱移植物重建前交叉韧带有助于移植肌腱的修复,临床疗效满意。     

Total Knee Arthroplasty in Patients With Extra-Articular Deformity: Restoration of Mechanical Alignment Using Accelerometer-Based Navigation System

Background

Total knee arthroplasty (TKA) in patients with post-traumatic extra-articular deformity (EAD) is difficult to manage using conventional instrumentation techniques. In this study, we evaluate whether accelerometer navigation system can be a valuable option to make accurate bone resections and restore the neutral mechanical axis in complex TKA patients with EAD.

Combined plate and nail fixation of bicondylar tibial plateau fractures

IntroductionBicondylar tibial plateau fractures with meta-diaphyseal comminution commonly have a compromised soft tissue envelope. Combined plate-nail fixation is an emerging technique that utilizes a limited anterolateral approach for plate application and percutaneous incisions for placement of an intramedullary nail. This technique alleviates the need for a separate medial approach to the proximal tibia. We report a series of patients treated with this approach and outline the steps for implementation.MethodsWe performed a retrospective review of 18 consecutive patients treated with combination lateral locked plating and intramedullary nailing at a single academic institution from 2016 to 2019. Of these, 16 patients met inclusion criteria and were included in this study. All patients had AO/OTA type 41C2/C3 fractures. Primary outcomes included coronal plane and sagittal plane alignment at latest follow up, rate of articular subsidence at latest follow up, and rate of postoperative infection.ResultsOf the 16 patients included, average followup was 8.2 months (range 0.1-29.7 months). At latest follow-up, average coronal alignment ranged from 0.8±1.2 degrees of varus (maximum 4.0 degrees) to 1.4±1.7 degrees of valgus (maximum 4.0 degrees). Average sagittal alignment ranged from 0.8±1.1 degrees of procurvatum (maximum 3.0 degrees) to 0.6±1.2 degrees of recurvatum (maximum 4.0 degrees). There was no radiographic evidence of articular subsidence at latest follow up for any patient. One patient (5.9%) presented at 141 days postoperatively with a draining wound and infection.ConclusionsCombination plate-nail fixation is a viable option for treating patients with select bicondylar tibial plateau fractures with meta-diaphyseal comminution. This case series with short-term followup demonstrates acceptable radiographic and clinical outcomes, as well as rates of postoperative infection and implant removal similar to those currently reported in the literature for other techniques used to treat these fractures.