Participation in Recreational Athletics After Operative Fixation of Tibial Plateau Fractures: Predictors and Functional Outcomes of Those Getting Back in the Game

Abstract

Background: Tibial plateau fractures can be devastating traumatic injuries to the knee, particularly in active athletes. Purpose/Hypothesis: The purpose of this study was to report on the return to participation in recreational athletics after operatively managed tibial plateau fractures. In addition, this study assessed factors associated with the ability to return to participation in recreational athletics after tibial plateau fractures treated with open reduction internal fixation and compared final outcomes between patients who were able to return to recreational athletics and those who could not. The hypothesis was that returning to participation in recreational athletics would be dependent on the time from surgery after operative fixation of tibial plateau fractures. Less severe injuries would be associated with a quicker return to athletics. Study Design: Case-control study; Level of evidence, 3. Methods: All tibial plateau fractures treated by 1 of 3 surgeons at a single academic institution over an 11-year period were prospectively followed. Final outcomes were evaluated using the Short Musculoskeletal Function Assessment at latest follow-up. All complications were recorded at each follow-up. Differences between the groups were compared using Student t tests for continuous variables. Chi-square analysis was used to determine whether differences between categorical variables existed. Logistic regression was performed to assess independent variables associated with returning to participation in recreational athletics. Results: A total of 169 patients who underwent operative management of their tibial plateau fracture reported participation in recreational athletics before their injury. By the 6-month time point, 48 patients (31.6%) had returned to participation in recreational athletics, and at final follow-up (mean, 15 months), 89 patients (52.4%) had returned to participation in recreational athletics. Predictors of returning to recreational athletics included white race, female sex, social alcohol consumption, younger age, increased range of motion (ROM), low-energy Schatzker patterns (I-III), injuries not inclusive of orthopaedic polytrauma or open fractures, and no postoperative complications. White race, social alcohol consumption, and increased ROM were associated with returning to athletics at both 6-month and final follow-up. Lack of a venous thromboembolism was associated with returning to athletics at final follow-up. Patients who returned to recreational athletics had associations with better functional outcomes and emotional status than those who did not. Conclusion: The number of patients who returned to participation in recreational athletics gradually increased over time after operative fixation of tibial plateau fractures. Less severe injuries and a lack of postoperative complications were associated with a quicker return to athletics. Predictors of returning to participation in recreational athletics after operatively managed tibial plateau fractures can be used to target patients at risk of not returning to play to provide interventions aimed at improving their recovery, such as early knee range of motion, muscle strengthening, and participation in low-impact activities.