Tibial plateau fractures account for 1% of all fractures [1]. These fractures are associated with an increased risk of post-traumatic arthritis. Operative management of tibial plateau fractures focuses on restoration of joint congruency and mechanical alignment, which are key factors in clinical and radiological outcomes of the knee [2].

However, there is controversy with regard to the management of soft tissue injuries associated with tibial plateau fractures. Diagnosis of soft tissue injuries relies on clinical examination, radiological investigations and intraoperative assessment. Numerous reports have shown concomitant soft tissue injuries are common [3], [4], [5], [6]. A recent systematic review including 877 patients showed 93% of tibial plateau fractures had associated soft tissue injuries, quoting 20.7% medial collateral ligament, 22.9% lateral collateral ligament, 36.8% anterior cruciate ligament, 14.8% posterior cruciate ligament, 48.9% lateral meniscus, and 24.5% medial meniscus [3].

Fracture patterns and their association with soft tissue injuries have also been the focus of many previous studies to assist in diagnosis [4], [5], [6]. It is not clear whether pre-operative or intra-operative diagnosis of a soft tissue injury impacts the management plan, and the subsequent outcome of treatment. Despite numerous efforts [3], [4], [5], there is no agreed diagnostic pathway for concomitant injuries, and so there is great variance in practice. Consequently, many soft tissue injuries are likely undiagnosed, and untreated which could lead to further complications in the future [7].

The literature describes a range of approaches and techniques for managing soft tissue injuries with tibial plateau fractures. These include a non-operative physiotherapy-based approach, whilst operative intervention involves open or arthroscopic-assisted repair or resection of the damaged structures with fracture fixation. Furthermore, the incidence of secondary surgeries required to manage soft tissue injuries or post-traumatic arthritis at a future date, has yet to be investigated [8].

To identify the impacts of various diagnostic methods on management of meniscal injuries associated with tibial plateau fractures.

We also aim to determine the management options utilised for meniscal injuries associated with tibial plateau fracture fixation and evaluate the clinical outcomes of operatively managed meniscal injuries with tibial plateau fixation.