Radiographic Osteoarthritis and Patient-Reported Outcomes One Year Following Tibial Plateau Fracture Surgery

Abstract

Introduction: This study aimed to characterize early clinical, functional, and radiographic outcomes after surgical treatment of tibial plateau fractures and to identify independent predictors of moderate-to-severe post-traumatic knee osteoarthritis (Kellgren-Lawrence (KL) grades 3-4) at 12 months, with emphasis on the relative contribution of fracture morphology and radiographic osteoarthritis severity. Materials and methods: We conducted a retrospective analysis of prospectively collected clinical data from consecutive adults who underwent open reduction and internal fixation of tibial plateau fractures at a tertiary trauma center between March 2017 and June 2025, with twelve-month follow-up completed by mid-2026. Fractures were classified using the Schatzker system. At 12 months, patients underwent standardized clinical and imaging follow-up, including Rasmussen clinical and radiologic scores, KL grading, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the 36-Item Short Form Health Survey (SF-36) physical and social functioning domains. Group comparisons between KL grades 0-2 and 3-4 were conducted using non-parametric tests. Multivariable logistic regression identified predictors of KL grades 3-4, and multivariable linear regression explored correlates of KOOS and SF-36 physical functioning. Results: Of 109 eligible patients, 106 (median age 43 years; 57.5% male) completed the 12-month evaluation. High-energy patterns predominated, with Schatzker types V-VI accounting for 51.8% of fractures. Median KOOS was 77; median SF-36 physical and social functioning scores were 80 and 88.5, respectively. While 80.2% of knees had KL grades 0-2, 19.8% already exhibited grades 3-4 and showed lower KOOS (median 63 vs 79) and lower SF-36 physical functioning (median 70 vs 82). In multivariable models, older age and female sex independently predicted KL grades 3-4, whereas fracture complexity did not. Moderate-to-severe osteoarthritis was the only variable independently associated with worse knee-specific and general physical function, corresponding to mean reductions of approximately 13 points in KOOS and 15 points in SF-36 physical functioning. No variable independently predicted Rasmussen clinical category. Conclusions: Most patients achieved satisfactory short-term outcomes after tibial plateau fracture surgery, yet nearly one-fifth exhibited moderate-to-severe radiographic osteoarthritis at the latest follow-up with clinically meaningful functional decrements. The Schatzker classification did not independently predict these outcomes, whereas early KL grades 3-4 emerged as the strongest correlate of functional impairment. Systematic integration of radiographic osteoarthritis grading with validated patient-reported outcome measures is essential for risk stratification and longitudinal follow-up planning.