Effect of Transverse Versus Longitudinal Incisions on Anterior Knee Pain After Tibial Nailing (TRAVEL)

Abstract

Background:Anterior knee pain is common after tibial nailing, and its origin is poorly understood. Literature suggests it may be related to infrapatellar nerve injury. The aim of this study was to compare the effect of a transverse (potentially infrapatellar nerve-sparing) incision versus a longitudinal incision for the insertion of a tibial nail with respect to anterior knee pain.Methods:Patients with a tibial shaft fracture undergoing treatment with use of an intramedullary nail were randomized to a transverse incision (n = 68) or longitudinal incision (n = 68) in multiple centers. The primary outcome measure was kneeling pain based on a numeric rating scale (NRS). Secondary outcome measures included knee pain during daily activities, functional outcome (Short Musculoskeletal Function Assessment and Lower Extremity Functional Scale), quality of life (EuroQol-5 Dimensions), activity resumption, complications, reoperations, and costs within 1 year after trauma.Results:At 12 months, the estimated marginal mean for kneeling pain was 2.4 (95% confidence interval [CI], 1.6 to 3.2) in the transverse incision group and 3.7 (95% CI, 3.0 to 4.5) in the longitudinal incision group. Regression analysis showed no significant difference between the groups over time. Knee pain scores for daily activities, functional outcome scores, and quality of life were also comparable between the groups. Signs of infrapatellar nerve injury were found less often after a transverse incision (18% versus 54%; p < 0.001). The median total (direct and indirect) costs per patient were €10,468 in the transverse incision group and €11,066 in the longitudinal incision group. Loss of productivity accounted for 67% and 52% of the total costs in the 2 groups, respectively.Conclusions:A transverse incision reduces injury to the infrapatellar nerve, but anterior knee pain scores and function are comparable after use of a transverse or longitudinal incision for tibial nail insertion.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

The absence of reporting standards and a lack of objective, performance-based outcomes following intramedullary nailing of tibial shaft fractures: findings from a scoping review into 179 articles

“…A substantial number of fractures (30%) did not have a specified nailing approach. One study [ 35 ] reported economic outcomes (Medical Consumption Questionnaire [ 36 ], Productivity Cost Questionnaire [ 37 ], and direct and indirect medical costs).…”

What’s New in Orthopaedic Trauma

“…Some authors have advocated for the use of a transverse, rather than longitudinal, incision when utilizing the suprapatellar approach, suggesting that the transverse incision can reduce the risk of infrapatellar nerve injury, potentially reducing rates of anterior knee pain. An RCT of 136 patients demonstrated that the transverse incision resulted in less infrapatellar nerve injury, but anterior knee pain and functional outcomes did not differ 16 .…”

Resultado Funcional E as Complicações Da Haste Intramedular Bloqueada De Tíbia Com Acesso Cirúrgico Suprapatelar E Infrapatelar

“…Essas fraturas podem acometer indivíduos de todas as idades, desde crianças até idosos, com incidência ligeiramente maior no sexo masculino em relação ao sexo feminino. A prevalência de fraturas diafisárias da tíbia pode variar entre diferentes populações devido a variações no estilo de vida, atividades e condições médicas subjacentes 2,3 .…”

“…Lesões relacionadas a esportes, especialmente aquelas que envolvem esportes de contato ou atividades de alto impacto, são outra causa comum de fraturas diafisárias da tíbia. Em alguns casos, essas fraturas também podem ocorrer devido a traumas de baixa energia em indivíduos com ossos enfraquecidos, como aqueles com osteoporose ou tumores ósseos [1][2][3] .…”

“…1 Ortopedista -Universidade de Vassouras. 2 Médico Residente 3° Ano Ortopedia e Traumatologia (Universidade federal de Juíz de Fora) 3 Médico Residente 3° Ano Ortopedia e Traumatologia (UNIFACIG). 4 Médico Residente 3º Ano Ortopedia e Traumatologia, Unifaa.…”