Arthroscopic-assisted tibial plateau fixation (AATPF) vs. Open reduction internal fixation (ORIF): A multicenter randomized controlled trial Project Summary/Abstract The current standard treatment for tibial plateau fracture fixation, open reduction internal fixation (ORIF), has significant limitations including surgical site infections, pain, stiffness, and a prolonged period of non-weight bearing restrictions. The large soft tissue dissection for ORIF is associated with an increased risk of surgical site infections, and limited visualization of joint reduction in this surgical approach is associated with an increased risk of future total knee arthroplasty secondary to post-traumatic osteoarthritis.1-6 Arthroscopic-assisted tibial plateau fixation (AATPF) provides direct visualization of the articular surface with minimal invasiveness, accelerated post-operative recovery, and preserves joint longevity.7,8 Several studies have reported good outcomes with low complication rates of AATPF for lateral tibial plateau fractures.9,10 However, there is no Level I evidence comparing outcomes of AATPF and outcomes of the traditional ORIF approach. We have designed a randomized controlled trial (RCT) comparing patient-reported, clinical, and radiographic outcomes of patients with lateral tibial plateau fractures treated with AATPF vs. ORIF to provide high level evidence-based data for clinicians. The proposed R34 pre-study planning period is essential to successfully initiate and complete the RCT.