A comparison of anterior knee pain, kneeling pain and functional outcomes in suprapatellar versus infrapatellar tibial nailing

Fontalis, Andreas; Weil, Simon; Williamson, Michael; Houston, James; Ads, Tamer; Trompeter, Alex

doi:10.1007/s00590-020-02851-8

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…In this study, we did not review postoperative anterior knee pain for the IP group, therefore, we can definitively compare knee pain between the two groups. However, we can state that our findings for anterior knee pain following SP tibial nailing are in keeping with current literature [16][17][18].…”

Section: Discussionsupporting

confidence: 92%

“…However, we did review postoperative anterior knee pain in the SP group, which is a well-established postoperative complication of IP tibial nailing. Published literature appears to show similar incidences of anterior knee pain in both infrapatellar and suprapatellar groups with some studies reporting reduced anterior knee pain in SP group [16,17]. We utilised the KOOS patient-reported outcome measures (PROMs) questionnaire for calculating knee pain following SP tibial fixation.…”

Section: Discussionmentioning

confidence: 99%

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Tibial Intramedullary Nailing by Suprapatellar Approach: Is It Quicker and Safer?

Jayaraju¹,

Rammohan²,

Awad³

et al. 2022

Cureus

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BackgroundWith the increasingly accepted method of suprapatellar tibial nailing for tibial shaft fractures, we aimed to compare intraoperative and postoperative outcomes of infrapatellar (IP) vs suprapatellar (SP) tibial nails. MethodsThis is a retrospective cohort analysis of 34 SP tibial nails over three years vs 24 IP tibial nails over a similar time frame. We compared total radiation dose (TRD), patient positioning time (PPT), fracture healing and follow up time. Knee pain in the SP group was evaluated utilising the Hospital for Special Surgery (HSS) Knee Injury and Osteoarthritis Outcome Score (KOOS). ResultsFifty-eight patients with a mean age of 43 years were included. Mean intraoperative radiation dose for SP nails was 61.78 cGy (range: 11.60-156.01 cGy) vs 121.09 cGy (range: 58.01-18.03 cGy) for IP nails (p < 0.05). Mean PPT for SP nails was 10 minutes vs 18 minutes for IP nails (p < 0.05). All fractures united in the SP group vs one non-union in the IP group. Mean follow up was 5.5 months vs 11 months in the IP and SP groups, respectively. Mean KOOS was 7 (range: 0-22) at six months for the SP group. ConclusionThe semi-extended position (SP group) leads to reduced TRD because of ease of imaging. Patients showed improved outcomes with shorter follow up and fracture union in all patients (SP group). The KOOS revealed that SP nail patients had minimal pain and good knee function. This study establishes a management and patient-reported outcome measures (PROMs) baseline for ongoing evaluation of SP nails.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Tibial Intramedullary Nailing by Suprapatellar Approach: Is It Quicker and Safer?

Jayaraju¹,

Rammohan²,

Awad³

et al. 2022

Cureus

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“…Por un lado, el procedimiento puede conducir al desplazamiento proximal del fragmento de fractura con la rodilla en flexión, lo que, en consecuencia, genera valgus y procurvatum, además, se genera inflamación en la extremidad, aumentando el riesgo de síndrome compartimental y alarga la duración quirúrgica [1,5]. Por su parte, es preciso señalar que el dolor postoperatorio en la parte anterior de la rodilla es la complicación más frecuente tras el enclavado tibial, y reporta una incidencia que varía del 10 al 86% de los pacientes [2,[6][7].…”

Section: Introductionunclassified

“…Varios estudios refieren que el enfoque suprapatelar permite la implantación más precisa del clavo, reduce el tiempo de la operación y de fluoroscopia, disminuye el riesgo de no unión, el dolor de rodilla anterior y previene los trastornos degenerativos de la articulación de la rodilla [2,3,5,8,9]. Sin embargo, existe una preocupación con esta técnica, debido a la existencia de un mayor riesgo de dañar las estructuras intraarticulares, especialmente el cartílago patelofemoral [1,3,[5][6].…”

Section: Introductionunclassified

Ventajas y desventajas del uso de clavo de tibia suprapatelar e infrapatelar en fracturas de tibia.

Rocha¹,

Campos²,

Gajardo³

et al. 2023

Preprint

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“…One well-documented disadvantage of IM nailing is long-term anterior knee pain (AKP), occurring in 10% [ 10 ] to 86% of cases [ 11 ]. AKP post-SPN has been reported as non-existent [ 5 ], significantly lower than IPN [ 8 ], and not different to IPN [ 12 – 15 ]. These differences may in part be explained by differing study designs and the range of scoring systems used being developed for various other knee pathologies [ 16 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Investigating and defining outcomes of suprapatellar versus infrapatellar intramedullary nailing of tibial shaft fractures: a protocol for a pilot randomised controlled trial

Thwaites

Thewlis

Hall

et al. 2022

Pilot Feasibility Stud

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Background Anterior knee pain is often reported following intramedullary nailing of tibial shaft fractures. The aetiology remains unclear, but the surgical approach may play an important role. To date, no biomechanically validated method exists to assess patient outcomes specific to anterior knee pain in this cohort. The central aims of this study are to (1) evaluate the feasibility of a full-scale randomised controlled trial (RCT) investigating the influence of surgical approach on intramedullary nailing of tibial shaft fractures (suprapatellar versus infrapatellar nailing), (2) explore differences in clinical outcomes between the approaches, and (3) explore the development of a biomechanically validated methodology for assessing post-operative anterior knee pain and knee function specific to intramedullary nailing of tibial shaft fractures. Methods This pilot study will follow a prospective randomised controlled design at the Royal Adelaide Hospital and The Queen Elizabeth Hospital (South Australia). This study aims to recruit 60 patients between 18 and 60 years old who will be randomly assigned to either the suprapatellar or infrapatellar approach following a decision for intramedullary surgical fixation by the treating surgeon. All nails in this study will be Stryker T2 Alpha nails. Patients will undergo standard radiograph, magnetic resonance imaging, and clinical assessments in-line with their standard operative care, and complete a number of patient-reported and performance-based outcome measures. Performance-based outcome measures will be assessed utilising three-dimensional motion capture techniques. Follow-up time points are 3, 6, 12, and 18 months. Feasibility outcomes include ability to meet enrolment and retention metrics, compliance with all questionnaires and assessment procedures, and the occurrence of any adverse events. The primary clinical outcome is the incidence of anterior knee pain at 12 months after surgery. Discussion This study will establish the feasibility and inform the design of a large-scale RCT. Evaluation of all clinical data and patient outcomes will lead to the development of a new tool for assessing patient outcomes in this cohort. Limitations of the study include an unpredictable enrolment rate and loss to follow-up, small sample size, and the unknown ability of three-dimensional motion analysis to pick up the effects of anterior knee pain after tibial nailing. Trial registration This trial was prospectively registered on the 7 February 2020 on ANZCTR, ACTRN12620000109909.

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A comparison of anterior knee pain, kneeling pain and functional outcomes in suprapatellar versus infrapatellar tibial nailing

Cited by 8 publications

References 27 publications

Tibial Intramedullary Nailing by Suprapatellar Approach: Is It Quicker and Safer?

Tibial Intramedullary Nailing by Suprapatellar Approach: Is It Quicker and Safer?

Ventajas y desventajas del uso de clavo de tibia suprapatelar e infrapatelar en fracturas de tibia.

Investigating and defining outcomes of suprapatellar versus infrapatellar intramedullary nailing of tibial shaft fractures: a protocol for a pilot randomised controlled trial

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