Biomechanical evaluation of the lower limbs in patients surgically treated for tibial plateau fractures: what is the involvement of the fascia?

Study Design: Retrospective, single-center follow-up study. Background: There is limited data on surgical and post-operative rehabilitation, functional outcomes and there are no studies investigating the long-term asymmetry between the lower limbs in patients surgically treated for TPF. The possibility of using equipment such as force plates and dynamometers (VALD, Brisbane, Australia), has raised research questions about the potential presence of asymmetry in the two lower limbs in patients treated for TPF. Objective: The study investigates: subjective perception, quality of life, possible presence of asymmetry in: AROM, maximal strength, power, static and dynamic stability and the RFD between the limb operated and the non-operated limb. The data given us by the technology allows us to explore the possible involvement of fascial structures in the execution of functional movements that require the use of the upper limbs, in contrast to those that primarily involve the lower limbs. The data also enable us to investigate the potential impact of fascial tissue functions on the operated limb compared to the contralateral limb. Methods: The study included patients who underwent surgery between 2009 and 2016 at the orthopedic-traumatological clinic of the university-hospital in Padua. 28 patients were recruited and underwent subjective evaluation (Tegner, Lyhsolm, NPRS, AKSS, KOOS-I, IKDC, and SF-36), clinical evaluation (Lachman, Pivot Shift, Jerk, anterior drawer, posterior drawer, varus-valgus stress test, Apley test, McMurray test, meniscal palpation, alignement and PVND), strength, joint range of motion, and RFD evaluation using a dynamometer and functional assessment of SLS, SJ, CMJ and CMJL on force plates and a p-value  to 5% was considered significant. Results: At an average follow-up time of 9,10 ± 2,33 years, follow-up visits were conducted on 28 individuals. They took an average of 9,71 ± 8,12 months to return to pre-injury activity levels. Subjective assessments yielded average scores of: 3,43% ± 1,17 for the Tegner Score, 83,25% ± 23,61 for the Lysholm Score, 0,68 ± 1,52 for the NPRS, 85,53% ± 23,78 for the AKSS, 77,62% ± 23,80 for the KOOS-I, 74,10% ± 18,00 for the IKDC, and 80,94% ± 17,44 for the SF-36. At the clinical examination no patients tested positive for Valgus Stress Test and Posterior Drawer Test; only one patient reported PVND following the surgery; the Apley and McMurray were the tests with the highest positivity rates, but only the Valgus Test showed significant positivity. The dynamometer evaluations showed a significant difference in terms of knee flexion strength, knee extension strength, flexion AROM, and extension AROM. From the statistical analysis conducted for the tests performed on force platforms, patients did not present statistically significant during the SLS. The average height achieved in the SJ was 10,30 ± 4,63, in the CMJ was 11,54 ± 5,14, and in the CMJL was 14,47 ± 6,17. The comparison between these showed a difference only between SJ and CMJL. Furthermore, a significant increase in concentric force impulse was observed between SJ and CMJ and SJ and CMJL. However, no differences were found when comparing concentric and eccentric force between SJ and CMJ and CMJL. The SJ is the functional movement that allowed the identification of highly significant lower limb asymmetries: concentric force, concentric RFD, landing force, and RFD during the landing phase indicating that the injured limb is weaker. In the execution of CMJ and CMJL, no marked asymmetry between the lower limbs was identified except for concentric force expression in CMJL, where a greater weakness of the operated limb was noted. Conclusion: The patients in this study demonstrated significant asymmetries in terms of joint strength and joint AROM between the two limbs. Ultimately, it cannot be excluded that fascial tissue is directly involved in the operated limb compared to the contralateral limb.