The medial tibial plateau is the larger and concave articular surface of the medial tibial condyle, covered by articular cartilage and the medial meniscus. It is approximately 40% larger than the lateral plateau and bears 60-70% of tibiofemoral load in neutral alignment. The medial plateau slopes posteriorly by approximately 10 degrees. It is the primary articular surface involved in medial compartment osteoarthritis.
Medial tibial plateau fractures (Schatzker type IV) are high-energy medial compression fractures requiring CT and MRI to assess articular comminution, meniscal tears, and ligament injuries. Medial plateau depression greater than 3 mm requires surgical elevation and bone grafting. In total knee arthroplasty, the medial tibial component resurfaces this surface with a polyethylene bearing; accurate resection depth and slope reconstruction are critical to implant longevity. Tibial slope affects ACL graft tension and knee kinematics.
High-energy varus loading shears or splits the medial tibial plateau from the tibial shaft, producing a severe periarticular fracture with associated ligamentous injury and risk of popliteal artery damage from medial translation; managed by open reduction and internal fixation with medial plating.
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