This retrospective study evaluated 18 patients in whom an extensile approach to the lateral tibial plateau involving anterior detachment and retraction of the lateral meniscus was used to improve visualization of the tibial articular surface. All patients in this study had a significantly comminuted tibial plateau fracture with a minimum articular depression of 10 mm. Four of the 18 patients had peripheral meniscal tears that were repaired at the time of tibial fixation. All patients had a minimum followup of 13 months. The average range of motion was 0 degrees to 117 degrees. None of the patients had evidence of meniscal symptoms. Functional evaluation revealed that 13 of the patients had an excellent result, 5 had a good result, and 1 a poor result. Five patients evaluated with arthroscopy showed complete healing of the anteromedial detachment site of the meniscus. Two of the 5 patients also had a meniscal repair that healed. For patients in whom there is significant comminution and depression of the lateral tibial plateau, this is a safe and effective method of treatment that provides excellent exposure of the articular surface to allow an accurate reduction.