Background Tibial plateau fractures (TPF) are complex injuries involving the articular surface of the proximal tibia, commonly managed with open reduction and internal fixation (ORIF). The aim of this management is to restore joint alignment whilst respecting the soft tissue envelope. The relationship between radiological factors on patient-reported outcomes (PROMs) remains unclear. This systematic review aimed to determine the association between articular reduction and PROMs following TPF.

Methods MEDLINE, Embase, Cochrane CENTRAL, ClinicalTrials.gov and Google Scholar databases were searched for English language articles between January 2000 to 5 May 2023, with 3300 studies screened. Eligible studies reported radiological and clinical outcomes in adult TPF patients managed with ORIF, with a minimum follow-up of two years. Data extraction and quality assessment were conducted independently by two reviewers using the Risk of Bias Assessment tool for Non-Randomised Studies (RoBANS). Linear regression models assessed the effect of articular reduction on PROMs.

Results A total of 30 studies met the inclusion criteria, comprising 1591 patients. Studies with >85% of cases achieving articular reduction within 2 mm reported significantly higher PROMs, particularly Hospital for Special Surgery (HSS) scores (p = 0.04). To analyse outcomes between studies that used different PROMs, a grouped analysis approach was utilised, which showed ‘excellent’ outcomes associated with cohorts in which higher rates of successful reduction were achieved when compared to ‘good’ outcomes (p = 0.04).

Conclusions Achieving higher rates of articular reduction increases the likelihood of excellent patient-reported outcomes. Additionally, studies in which a larger proportion of the cohort achieved reduction reported significantly higher PROMs compared to those with fewer patients achieving anatomical reduction. This study also introduces a novel method to standardise the reporting of different PROMs in a meta-analysis, enabling comparison of heterogeneous data.

One author has conducted paid consultancy work for Gyder Surgical and holds a directorship at Osteo-X Devices.

This study did not receive any funding.

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All data produced in the present study are available upon reasonable request to the authors