Pre-injury athletic activity and functional recovery after surgical fixation of Schatzker I-II tibial plateau fractures in patients over 65 years: a state-of-the-art review| Lo Scalpello - Journal

Abstract

Objective. To evaluate the impact of pre-injury physical and athletic activity on functional recovery following surgical fixation of Schatzker I-II tibial plateau fractures in patients over 65 years of age.

Methods. A comprehensive literature search was performed using the Consensus platform, which indexes more than 170 million scientific articles across major biomedical databases, and was complemented by a targeted manual search. A total of 1,141 records were identified. Following de-duplication, title/abstract screening and full-text eligibility assessment against pre-specified inclusion and exclusion criteria, 50 studies met eligibility and were reviewed; the 22 most relevant and methodologically robust studies (> 2,200 patients with extractable data) form the core evidence base and are tabulated. Study selection is summarized in a PRISMA-style flow diagram, and the strength of each key claim was appraised using an explicit three-tier grading scheme. No formal meta-analysis was performed; a qualitative synthesis was undertaken.

Results. Across the available literature, patients with higher levels of pre-injury physical or athletic activity consistently demonstrated superior early functional recovery, including earlier return to independent ambulation and higher early functional scores. However, these differences tended to diminish over time, with comparable mid- to long-term functional outcomes reported between athletic and non-athletic patients. Complication rates were more strongly associated with fracture morphology, fixation strategy, and comorbidities than with baseline activity level alone.

Conclusions. Pre-injury physical activity appears to be a relevant determinant of early functional recovery following surgical fixation of Schatzker I-II tibial plateau fractures in patients over 65 years. Although long-term outcomes tend to converge, recognition of baseline functional status may improve patient counselling, rehabilitation planning and expectation management in the increasingly active elderly population.