All eligible cases were enrolled in the study. The 10 excluded cases (11.90%) included three cases with a history of surgical or traumatic knee experience (one case in the arthroscopic group and two cases in the ORIF group ), three cases of patients < 18 years old (ORIF group), two cases with comorbid ACL rupture (ORIF group), one case who died 3 weeks after discharge (ORIF group), and one case who was lost to follow-up (arthroscopic group 1, 1.19%). Of the remaining 74 patients (41 men and 33 women), 58 underwent arthroscopy, and 16 underwent ORIF, with an average follow-up time of 35.27 ± 8.88 months (24–57 months) and an average age of 43.23 ± 0.36) years (20–69 years). Causes of injury were as follows: 35 cases of motorized two-wheeler accidents (arthroscopic Group 28, ORIF Group 7), 17 cases involving falling from a height (arthroscopic Group 9, ORIF Group 6), 13 sports injuries (11 cases in the arthroscopic group, 2 in the ORIF group), and 9 injuries were sustained while descending steps (8 in the arthroscopic group, 1 in the ORIF group). The mean days from trauma to operation was 5.32 ± 1.99 (days). The mean operative time was 71.16 ± 10.5145(min). There were no postoperative complications, including infection, nonunion of the fracture, and failure of internal fixation requiring secondary surgical removal.
The results of the univariate analysis identified Meyers-McKeever (χ2 = 4.669, P = 0.031) and surgical approach (χ2 = 9.428, P = 0.002) as factors potentially affecting surgical outcomes (Table 1). Using a Lysholm score ≥ 85 as the criterion for efficacy determination16, a logistic multiple regression analysis of several variable potentially affecting treatment efficacy revealed that Meyers-McKeever typing (OR = 10.763, P = 0.036, [95% CI, 1.174–98.693]) and surgical approach (OR = 9.274, P = 0.008, [95% CI, 1.794–47.934]) were independent risk factors (Table 2).
Table 2
multi-factor logistic regression
Related Factors | β | S. E | Wald | df | Sig. | Exp(B) | 95% CI of Exp(B) |
Lower | Upper |
Constant | − .164 | .609 | .072 | 1 | .788 | .849 | - | - |
Surgical Approach | 2.227 | .838 | 7.062 | 1 | .008 | 9.274 | 1.794 | 47.934 |
Meyers-McKeever Type | 2.376 | 1.131 | 4.417 | 1 | .036 | 10.763 | 1.174 | 98.693 |
Sixteen pairs of comparable data were obtained by PSM. Analysis of the data indicated that operative time (70.56 ± 10.91[min] vs 71.75 ± 10.42[min]), P = 0.766), affected side KT-1000 (4.875 ± 2.557[mm]vs 5.25 ± 2.739[mm]), P = 0.239) and healthy side KT-1000 (2.088 ± 0.761[mm] vs1.938 ± 0.7679[mm], P = 0.172) did not differ between the two groups. However, VAS score for incision (4.063 ± 1.289) vs 5.438 ± 1.459, P = 0.008), Lysholm score ( 96 (interquartile rang (IQR), 91 to 97) vs 87.5 (IQR, 82 to 92.25), P = 0.019), IKDC (96.5 (IQR, 93 to 98.25) vs 87.5 (IQR, 81 to 90.25), P = 0.002), and A-KT/H-KT (1.3 (IQR, 1.1 to 1.92) vs 4 (IQR, 2.95 to 4.9), P<0.001) exhibited statistically significant differences (Table 3).
Table 3
Characteristics of patients underwent arthroscopic approach and ORIF
Variables | Arthroscopy (n = 16) | ORIF (n = 16) | P-value |
Sex, n (%)a | | | 0.031 |
Male | 6 (38) | 13 (81) | |
Female | 10 (62) | 3 (19) | |
Age(years), Median (Q1, Q3) b | 47.5 (33, 52.25) | 48.5 (35.5, 55.25) | 0.806 |
Cause of injury, n (%)a | | | 0.235 |
Electric bicycle accident | 7 (44) | 7 (44) | |
Falling from height | 2 (12) | 6 (38) | |
Sports injury | 6 (38) | 2 (12) | |
Step down accident | 1 (6) | 1 (6) | |
Days of hospitalization (Days), Median (Q1, Q3) b | 8 (6.75, 9.25) | 8 (7, 11.25) | 0.285 |
Days from trauma to operation (Days), Median (Q1, Q3) b | 5.00(4.00,6.00) | 5.50(4.00,6.25) | 0.848 |
Mean of Operative time, minutes (SD) c | 70.56(10.91) | 71.75(10.42) | 0.766 |
Meyers McKeever Type, n (%)a | | | 1 |
Ⅱ | 1 (6) | 2 (12) | |
Ⅲ | 5 (31) | 4 (25) | |
Ⅳ | 10 (62) | 10 (62) | |
Meniscal Tears, n (%)a | | | 1 |
NO | 6 (38) | 6 (38) | |
YES | 10 (62) | 10 (62) | |
External fixation, n (%)a | | | 0.722 |
NO | 10 (62) | 8 (50) | |
YES | 6 (38) | 8 (50) | |
labour or sports, n (%)a | | | 1 |
NO | 5 (31) | 5 (31) | |
YES | 11 (69) | 11 (69) | |
Follow up time (Months), Median (Q1, Q3) b | 31.5 (25.5, 40.25) | 38 (26, 45.25) | 0.335 |
Mean VAS score for incision, (SD)* c | 4.063 (1.289) | 5.438 (1.459) | 0.008 |
Lysholm scores, Median (Q1, Q3) b | 96 (91, 97) | 87.5 (82, 92.25) | 0.019 |
IKDC score, Median (Q1, Q3) b | 96.5 (93, 98.25) | 87.5 (81, 90.25) | 0.002 |
Mean of Affected side KT-1000 A-KT, mm (SD) c | 4.875 (2.557) | 5.25 (2.739) | 0.239 |
Mean of Healthy side KT-1000 H-KT, mm (SD) c | 2.088 (0.761) | 1.938 (0.767) | 0.172 |
A-KT/H-KT, Median (Q1, Q3) b | 1.3 (1.1, 1.92) | 4 (2.95, 4.9) | < 0.001 |
MCID, n (%)a | | | 1 |
Lysholm score | 10(62.5) | 10(62.5) | |
IKDC | 10(62.5) | 10(62.5) | |
A-KT/H-KT | 15(93.75) | 15(93.75) | |
*Scores on the VASs for pain range from 0 to 10, with higher scores indicating more severe pain.
a chi-squared test with Yates’ continuity correction.
b Fisher’s exact test.
c independent-samples t-test.
IKDC, International Knee Documentation Committee ; A-KT, affected-side KT-1000 value; H-KT, healthy-side KT-1000 value; SD, standard deviation; VAS, visual analogue scale; MCID, minimal clinically important difference; Q1, lower quartile; Q3, upper quartile.