Medial Tibial Plateau
By Demetria Velazquez, DPT, PT
Medial Tibial Plateau
Medial Tibial Plateau (What and where is it):
The tibial plateau is a bony surface on the top of the lower leg (shin) bone that connects with the thigh bone (femur). The medial tibial plateau is the surface on the side corresponding to your big toe, whereas, the lateral tibial plateau is on the side corresponding to your pinky toe. The picture below depicts a front (anterior) view and a back (posterior) view to illustrate the difference in locations between the medial and lateral tibial plateau.
Why is it important / What attaches here?
This area is commonly known as the knee joint. Due to the ligaments and blood vessels supplying and protecting this joint, a fracture to the area where the shinbone (tibia) meets the thigh bone (femur) is very significant. On the medial side of the knee, the medial collateral ligament (MCL) connects the thigh (femur) bone to the shin (tibia) bone. In between the two bones is the medial meniscus, cartilage that cushions the bones. Lastly, the anterior cruciate ligament (ACL), attaches from the femur to the tibia at an angle in the center of the knee joint. Thus, a fracture to the upper medial (inside) portion of the tibia affects the knee joint and will most likely affect the ligaments and blood supply that closely attach and run through this area.
What causes a fracture to this area?
A medial tibial plateau fracture usually occurs due to trauma. This can include:
- Falls – especially in elderly due to osteoporotic bone changes
- Motor vehicle accidents
- Sports-related injuries – usually occurs when the knee forcibly moves inward or outward with the planting of the foot.
What are the typical signs and symptoms of Medial Tibial Plateau Fracture?
- Knee effusion – swelling
- Pain and tender to the touch
- Decreased motion – loss of ability to straighten or bend the knee
- Unable to bear weight through the affected limb
- Appearance – the knee may appear deformed due to a traumatic fracture
- Bruising – due to blood in the tissues surrounding the knee joint
Diagnostic Tests for a Medial Tibial Plateau Fracture:
- Radiographs (x-rays) are usually the first source a physician will utilize to diagnose a medial tibial plateau fracture.
- CT scans may also be to determine the degree of the fracture.
- An MRI may be used to determine if the injury also involved the meniscus or near by ligaments.
Is immediate medical attention necessary?
Yes! This area is very close to important blood vessels and nerves, which can also be affected with a traumatic fracture. Complications can include:
- Artery or nerve damage
- Compartment syndrome – swelling compresses the blood supply and nerves of the lower leg. If not treated, these vessels/nerves can die and amputation would be necessary.
Clean and uncomplicated fractures, crack in the bone but the bone remains in proper alignment, are usually treated non-surgically with casting/splinting or a knee brace/immobilizer. Complicated or displaced fractures (bone is not aligned) may require surgical treatment. The degree and type of fracture usually determines surgical options, which may involve screws or plates to support the bones for healing to occur.
Recovery can take several months due to limited weight bearing allowed through the limb until the fracture has healed. The type and degree of fracture, as well as the need for surgical intervention or complications, will impact these healing timeframes. Physical therapy will be prescribed, regardless of a surgical or non-surgical treatment plan, in order to restore motion and strength for walking and return to functional activities.
- Physical therapy will focus on:
- Regaining full motion through the knee joint
- Restoring strength to put weight through the affected leg
- Exercises for improved ability to walk, squat, ascend/descend stairs, and return to previous activity levels
Long-term Expectations after rehab:
A common long-term complication from medial tibial plateau fractures is osteoarthritis in the knee joint. Therefore, patients with a medial tibial plateau fracture have a higher risk of needing a total knee replacement in the future. Age, the degree of fracture and involved ligaments or cartilage, and pre-existing injuries to the knee also affect this risk.
If you think you have knee pain resulting from a possible medial tibial plateau injury JOI has a team of physicians that specializes in knee conditions. Call JOI-2000 to book your appointment today!