Recent news of an injury to safety Daniel Sorensen brought a press release from the team stating that he underwent surgical intervention to address at least one injury suffered in practice the other day.
As the team stated, Sorensen suffered a torn lateral meniscus, an MCL injury and a tibial plateau fracture, which was repaired.
While the first two conditions are fairly well known, I believe the least well known of the three deserves some explanation. The purpose of this article is to discuss what a tibial plateau fracture is and why it requires surgery to address the issue.
Since we have not been given information on what side (medial or lateral) the fracture is on, we will not assume anything from that standpoint. What one needs to know is that the tibia (biggest bone of the lower leg or the shin bone) has two distinct sides to it, with a ridge in the middle at the top.
There are several fracture types, as you can see in the picture below. The first three types are typically lower-level energy injuries. The last three require significant forces due to the number of fragments involved. Because of the level of these forces, there is typically a very high rate of associated injury to other structures, such as the MCL and meniscus in the case of this player.
It should be noted, however, that any type can have an additional injury with it.
Types of tibial plateau fractures
In addition to understanding what a tibial plateau fracture is, it important to note why a repair is needed.
Alignment of the bone in this area is critical due to the amount of motion that occurs here. The articular cartilage (smooth shiny covering over the bone) must be in alignment in order to prevent a number of issues further down the road, including loss of range of motion and development of early arthritis.
Not all fractures need to be repaired in the body. However, the interaction of the tibia and femur (upper leg bone) requires a smooth surface in order for knee flexion and extension to occur. An unrepaired fracture could prevent that.
As was mentioned in the press release, the timeframe of six weeks is critical, as that is a classic benchmark of bone healing. Science has told us not to expect bone to heal any quicker than that, at a minimum. Football activity prior to that would put the repair at risk of failure and mal-alignment.
When it comes to rehabilitation for these injuries, there is a timeframe of complete non-weightbearing determined by a number of factors such as size and location of the repair. This is done for healing and in order to not put any stress through the repair site. The tibia bears the vast majority of the weight put through the leg, therefore it is critical that it is given time to heal appropriately.
Non-weightbearing exercises can be done at this point, slowly progressing to weightbearing as is allowed by symptoms and physician findings on X-rays.
As with all knee injuries, maintaining lower extremity strength and conditioning is key. There is plenty of work to be done even while non-weightbearing–biking, pool therapy and non-weightbearing exercise, such as table or floor work.
Next, a period of acclimatization will occur with the athlete returning to ground-based activities and return-to-sport training. Constant monitoring of symptoms and re-evaluation will occur as the player begins a to return to football.
A return to practice, whenever that occurs, signifies that the player’s repair has been deemed successful and healed to the point where activity is now safe.
Players have returned from these injuries in the past without long-term effects or decreases in play.