Management of comminuted extraarticular inferior pole patella fractures with partial patellectomy and patellar tendon repair by transosseous sutures

Srikant, Konchada; Mishra, Debasish; Sinha, Vijoy Kumar; Pradhan, Sandeep

doi:10.5455/ijmsph.2017.0925311092017

Cited by 2 publications

(2 citation statements)

References 12 publications

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“…27 To overcome the disadvantages of heavy gauge steel wire, several studies have used nonmetallic implants, such as nonabsorbable suture and biodegradable cannulated screws. 9,14,15,[28][29][30] Most of these studies showed favorable clinical outcomes, with minimal postoperative complications (Table 2 14,28,29,[31][32][33][34][35][36][37][38][39][40][41][42] ).…”

Section: Wongthongsalee and Chobpenthaimentioning

confidence: 99%

Transosseous Suture With an All-FiberWire Technique in Patellar Fracture Fixation

Wongthongsalee

Chobpenthai

2022

Techniques in Orthopaedics

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Background: Patellar fractures account for 0.5% to 1.5% of all bone fractures. Tension band wiring with heavy gauge steel wire and K-wires is traditionally procedure for treating patellar fractures. However, this method is associated with implant-related complications. Present study aimed to evaluate functional clinical outcomes of patellar fracture fixation with transosseous suture using an all-FiberWire technique.Methods: This was a retrospective study involving 16 patellar fractures patients were repaired by open reduction and internal fixation with FiberWire using a 3-transosseous tunnel technique. The functional outcomes were evaluated with Tegner-Lysholm and Bostman scoring. We also evaluated clinical and radiologic outcomes. Results:The mean time to bony union was 8.87 1.54 weeks (range, 7 to 12 wk). The mean Bostman score at final follow-up was 27.13 2.5 (range, 21 to 30), and mean Lysholm score at final followup was 90.69 5.75 (range, 83 to 100). Fractures healed in all patients, with no fixation failures. Minor loss of reduction (< 2 mm) were observed in 3 patients (18.75%). No patient has reoperation. One patient developed knee stiffness, with an infected hematoma 10 weeks postoperatively. None of patients developed anterior knee pain postoperatively. Two patients (12.5%) developed mild localized pain from prominent suture knots. There were no significant implant-related complications and no repeat surgery was necessary. Conclusions:The use of nonmetallic sutures with an all-FiberWire technique in patellar fracture fixation avoids implant-associated complications and possibility of a second surgery to remove metal implants. Nonmetallic high-resistance FiberWire matches traditional metallic fixation, with a reduced risk of postoperative complications.

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Section: Wongthongsalee and Chobpenthaimentioning

confidence: 99%

Transosseous Suture With an All-FiberWire Technique in Patellar Fracture Fixation

Wongthongsalee

Chobpenthai

2022

Techniques in Orthopaedics

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“…Options include tension band wiring, circumferential wiring, fixation with plate and screws, and, in the setting of inferior pole comminution, a partial patellectomy with reattachment of the patellar tendon. 5,12,[16][17][18] A common technique is partial patellectomy and patellar tendon reattachment using transosseous tunnel (TT), with data demonstrating superior patient-reported outcomes and fewer hardware-related complications when compared with tension band wiring. 8 Recently, there has been interest in the use of suture anchor (SA) for patellar tendon repairs.…”

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confidence: 99%

Suture Anchor Versus Transosseous Tunnel Repair for Inferior Pole Patellar Fractures Treated With Partial Patellectomy and Tendon Advancement: A Biomechanical Study

O’Donnell

Lemme

Marcaccio

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Comminuted inferior pole patellar fractures can be treated in numerous ways. To date, there have been no studies comparing the biomechanical properties of transosseous tunnels versus suture anchor fixation for partial patellectomy and tendon advancement of inferior pole patellar fractures. Hypothesis: Suture anchor repair will result in less gapping at the repair site. We also hypothesize no difference in load to failure between the groups. Study Design: Controlled laboratory study. Methods: Ten cadaveric knee extensor mechanisms (5 matched pairs; patella and patellar tendon) were used to simulate a fracture of the extra-articular distal pole of the patella. The distal simulated fracture fragment was excised, and the patellar tendon was advanced and repaired with either transosseous bone tunnels through the patella or 2 single-loaded suture anchors preloaded with 1 suture per anchor. Load to failure and elongation from cycles 1 to 250 between 20 and 100 N of force were measured, and modes of failure were recorded. Statistical analysis was performed using a paired 2-tailed Student t test. Results: The suture anchor group had less gapping during cyclic loading as compared with the transosseous tunnel group (mean ± SD, 6.83 ± 2.23 vs 13.30 ± 5.74 mm; P = .047). There was no statistical difference in the load to failure between the groups. The most common mode of failure was at the suture-anchor interface in the suture anchor group (4 of 5) and at the knot proximally on the patella in the transosseous tunnel group (4 of 5). Conclusion: Suture anchors yielded similar strength profiles and less tendon gapping with cyclic loading when compared with transosseous tunnels in the treatment of comminuted distal pole of the patellar fractures managed with partial patellectomy and patellar tendon advancement. Clinical Relevance: Suture anchors may offer robust repair and earlier range of motion in the treatment of fractures of the distal pole of the patella. Clinical randomized controlled trials would help clinicians better understand the difference in repair techniques and confirm the translational efficacy in clinical practice.

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Management of comminuted extraarticular inferior pole patella fractures with partial patellectomy and patellar tendon repair by transosseous sutures

Cited by 2 publications

References 12 publications

Transosseous Suture With an All-FiberWire Technique in Patellar Fracture Fixation

Transosseous Suture With an All-FiberWire Technique in Patellar Fracture Fixation

Suture Anchor Versus Transosseous Tunnel Repair for Inferior Pole Patellar Fractures Treated With Partial Patellectomy and Tendon Advancement: A Biomechanical Study

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