PubMed^® Literature Review

Arthroscopy-assisted reduction and fixation (ARIF) has emerged as an alternative technique aimed at minimizing soft tissue trauma while allowing for precise fracture reduction and treatment of concomitant intra-articular pathologies [2-4].

The use of ARIF in treating Schatzker I-III tibial plateau fractures has been supported by several studies demonstrating favorable clinical outcomes with minimal complications. Compagnoni et al. reported excellent Rasmussen scores and Visual Analog Scale (VAS) scores in four patients treated with ARIF at short-term follow-up [2]. Similarly, Chan highlighted the advantages of arthroscopy-assisted procedures over traditional open methods, including direct visualization for accurate fracture reduction and reduced morbidity [3].

Shamrock et al.'s matched cohort analysis comparing AATPFF against traditional fixation techniques revealed that AATPFF is associated with significantly lower rates of minor medical complications (8.2% vs 2.7%), major medical complications (9.9% vs 4.6%), surgical complications (13.2% vs 2.7%), and emergency department visits within 90 days post-surgery [4]. This suggests that ARIF not only maintains comparable efficacy in achieving anatomical reduction but also enhances patient safety by reducing postoperative complication risks.

However, despite these promising results, concerns remain regarding the potential limitations of ARIF, such as its technical demand and learning curve which might limit its widespread adoption [5]. Moreover, there's ongoing debate on whether it can achieve equivalent articular surface restoration compared to open reduction internal fixation (ORIF), especially in more complex or bicondylar fractures where optimal plate positioning is crucial for stability [1].

Le Baron et al.’s study provided a comparative analysis between ARIF and ORIF for Schatzker I-III fractures indicating no significant differences in clinical outcomes or radiological signs of osteoarthritis long term; however they noted that ARIF offered slightly better Hospital for Special Surgery (HSS) scores than ORIF did [6]. This reinforces the notion that while both techniques are viable options for managing selected tibial plateau fractures, surgeon expertise plays a critical role in determining the most appropriate approach.

Jiang et al.’s systematic review further supports this perspective by showing that compared to ORIF, ARIF leads to faster postoperative recovery better clinical function without compromising on radiological outcomes or increasing complication rates significantly [12].