Knee Pain After Intramedullary Nailing of Tibia Fractures: Prevalence, Etiology, and Treatment

Bishop, Julius A.; Campbell, Sean T.; Eno, Jonathan-James; Gardner, Michael J.

doi:10.5435/jaaos-d-18-00076

Cited by 15 publications

(13 citation statements)

References 35 publications

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“…However, MRI and arthroscopic assessment of the patellofemoral joint after SPN and IPN suggests minimal risk [ 5 , 14 ], and several anatomical studies show similar articular damage between approaches [ 83 – 85 ]. The influence of nail removal (if it occurs) should also be considered, as removal is always performed via an infrapatellar incision, regardless of the initial approach [ 86 ].…”

Section: Discussionmentioning

confidence: 99%

“…The aetiology of AKP remains unclear [ 86 ], yet the choice of approach may play an important role: patients undergoing SPN may be more prone to loss of quadriceps function and damage to intra-articular structures; whereas IPN patients may suffer from increased likelihood of damage to the patellar tendon, fat pad, and saphenous nerve. A meta-analysis of 20 papers found an average of 47% of patients reported AKP at an average follow-up of 2 years, although how the AKP was assessed was not detailed in the review [ 87 ].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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

View full text Add to dashboard Cite

show abstract

“…[3,6] Multiple etiologies of postoperative anterior knee pain exist, including implant prominence, injury to intra-articular structures, patellar tendon or fat pad injury, damage to the infrapatellar branch of the saphenous nerve, and altered biomechanics. [11] The suprapatellar approach avoids the branches of the saphenous nerve and also spares the patellar tendon, potentially lowering the risk for anterior knee pain. [2,14] Several studies have evaluated outcomes of anterior knee pain following SP and IP approaches.…”

Section: Anterior Knee Painmentioning

confidence: 99%

Suprapatellar versus infrapatellar approach for intramedullary nail fixation of tibial shaft fractures: a review of the literature

Ringenberg

Tobey

Horinek

et al. 2022

OTA International: The Open Access Journal of Orthopaedic Trauma

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Semi-extended suprapatellar intramedullary nail fixation of tibial fractures has recently been gaining popularity. Several recent studies and meta-analyses compare the outcomes of the suprapatellar approach with the traditional infrapatellar approach. Despite concerns with intra-articular placement of instruments, studies show the suprapatellar approach to be a safe alternative. Several articles conclude that the suprapatellar approach may be superior to the infrapatellar approach. This review discusses recent findings comparing suprapatellar and infrapatellar approaches for nail insertion.

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“…5 Causes of anterior knee pain following intramedullary interlocking nail include skin incision, injury to the intra-articular structures, size of tibial plateau and damage to the infrapatellar branch of the saphenous nerve. 6 Several studies in the literature have shown that the position of the proximal nail tip may be one of the causative factors of anterior knee pain after tibia nailing. One of the studies showed that anterior knee pain results due to anterior nail prominence of more than 5mm and superior prominence of nail closer to the tibial articular surface.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Effects of Different Nail Tip Positions on Anterior Knee Pain After Intramedullary Interlocking Nailing for Tibial Shaft Fractures

Hassan

Anwar

Hassan³

et al. 2021

PAFMJ

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Objective: To determine the frequency of anterior knee pain after intramedullary interlocking nailing in tibial shaft fractures and to compare the intensity of anterior knee pain between positive and negative anterior cortex nail groups.Study Design: Quasi-experimental study. Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital Rawalpindi, from Oct 2018 to Apr 2019. Methodology: 100 cases of tibial shaft fracture were divided into two groups according to anterior cortex nail distance. Patients 18-40 years of age of both genders, closed fractures, Gustilo Andersen I open tibial diaphyseal fractures and nail tip more than 5mm from tibial tuberosity were included. Patients with osteoarthritis, pathological fractures, renal disease, open fracture GA-II & GA-III and knee instability were excluded from the study. Both groups with positive and negative anterior cortex nail distance were compared for pain using the chi-square test. Results: Frequency of anterior knee pain after intramedullary interlocking nailing in tibial shaft fractures was found in 24% of patients. 8 (16%) out of 50 patients in the group with nail tip deep to anterior cortex had anterior knee pain while 16 (32%) out of 50 patients in the group with nail tip protruding from anterior cortex suffered anterior knee pain (p-value = 0.061). Conclusion: Intramedullary interlocking nailing in tibial shaft fractures with nail tip deep to anterior cortex showed less pain as compared to nail tip protruding from anterior cortex although it was not statistically significant.

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Knee Pain After Intramedullary Nailing of Tibia Fractures: Prevalence, Etiology, and Treatment

Cited by 15 publications

References 35 publications

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

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

Suprapatellar versus infrapatellar approach for intramedullary nail fixation of tibial shaft fractures: a review of the literature

Comparison of Effects of Different Nail Tip Positions on Anterior Knee Pain After Intramedullary Interlocking Nailing for Tibial Shaft Fractures

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