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Objectives and questions: Posterolateral tibial plateau compression fractures (PTPCF) are frequently associated with anterior cruciate ligament (ACL) injuries and are a key factor contributing to postoperative instability and graft failure. The necessity of additional osteosynthetic fixation remains controversial. This study aims to analyze whether arthroscopic-assisted transtibial fracture reduction with isolated bone grafting provides sufficient stability for the treatment of PTPCF in the context of ACL injuries and leads to excellent radiological and subjective outcomes, thereby avoiding the need for osteosynthesis.

Material and methods: This retrospective study analyzed patients treated for ACL rupture with concomitant PTPCF. A total of 24 patients (31.3% females) with a mean age of 47.5 9.3 years were included. Clinical and radiological data were collected, including injury mechanism, affected side, and demographic characteristics. Radiological outcomes were assessed using MRI and radiographic imaging. Several patient-reported outcome measures were obtained, including the International Knee documentation Committee Score (IKDC), Lyholm score, Tegner score, and visual analog scale (VAS) for pain. Patients underwent simultaneous ACL reconstruction combined with arthroscopically assisted transtibial fracture reduction and allogeneic bone grafting, performed without osteosynthesis.

Results: Patients treated with transtibial fracture reduction and isolated bone grafting demonstrated good outcomes, with a mean IKDC of 83 ± 12. In the follow-up MRI, the lateral meniscus was consistently observed to be fully supported by the tibial plateau in all cases with no signs of loss of reduction. No major complications related to fracture healing were observed.

Discussion and conclusions: Transtibial reduction and isolated bone grafting without additional osteosynthetic fixation provides excellent stability for PTPCF associated with ACL injuries. The procedure yields favorable radiological and functional outcomes while avoiding implant-related complications. In cases of PTPCF with significant tibial plateau depression (Bernholt 2a–3b), arthroscopically assisted transtibial fracture reduction combined with allogeneic bone grafting, without osteosynthesis, may serve as a viable and minimally invasive alternative to osteosynthesis.