Analysis of Ankle Range of Motion in patients with Tibial Plateau Fractures: A Cross-Sectional Study

Tibial plateau fractures are fractures of the proximal aspect of the tibia involving the articular surface, subchondral bone, and metaphysis. These fractures affect the primary weight-bearing joint, i.e., the knee joint. This type of fracture most commonly occurs due to high-energy trauma (e.g., road traffic accident, fall from height) in young adults and due to low-energy trauma (e.g., falls, twisting injuries during simple activities like turning) in the elderly.  The incidence of tibial plateau fractures is 10.3 per 100,000 people per year and constitutes about 1-2% of all fractures in our nation. These fractures are classified based on the Schatzker classification. This classification is often used to plan the type of surgical procedure to restore joint congruity and alignment.  Depending on the type of approach taken during the surgical procedure, the muscles that are commonly retracted and cut are the tibialis anterior, peroneal, gastrocnemius, iliotibial band, semimembranosus, and quadriceps. Since the muscles are retracted and cut, it could possibly lead to arthrogenic inhibition of the muscles connecting both knee and ankle, altering ankle function.  According to the kinetic chain theory, there is a biomechanical link between the proximal and distal tibiofibular joints.  Due to the biomechanical interdependence of the ankle and knee joints, restricted ankle dorsiflexion may result in modified knee kinematics and compensatory mechanisms that put more strain on the knee joint. This interaction is essential for functional tasks like walking and squatting.This could be a reason as to why there can be alterations in ankle biomechanics with the tibial plateau affecting the kinetic chain, including the ankle, knee, and overall lower limb.

Although the tibial plateau fracture affects the knee, studies show gait deviation and altered joint loading persist even after one-year post-surgical fixation, leading to compensatory stress at the ankle. The literature lacks objective quantification on how the ankle and, in turn, the gait are affected.  The ankle is a crucial joint for not only weight-bearing activities but also balance and proprioception. Given that this type of fracture follows a prolonged non-weight-bearing phase, ankle joint mobility can indirectly be compromised.  The ankle complex is often overlooked because the primary target is the knee from a targeted rehabilitation point of view.  This can contribute to altered gait, instability, and other systemic changes, which can lead to poor functional outcomes and reduce the quality of living.  Since most literature focuses on knee recovery after tibial plateau fractures, the ankle joint is often overlooked despite its biomechanical link through the kinetic chain. This study will encourage a more holistic approach to rehabilitation.

 Hence, there lies a need to assess and analyze the range of motion of the ankle in patients with tibial plateau fracture after they commence full weight bearing.