Trochlear Lesion Caused by Suprapatellar Intramedullary Nailing and Treated with Autologous Chondrocytes Implant

Abstract

Introduction:Intramedullary nailing remains the most common method of treatment for tibial shaft fractures. The suprapatellar technique has proven to be useful in gaining and maintaining alignment, especially in proximal one-third tibia shaft fractures. It has been adopted by many surgeons taking trauma call, because it requires less set-up time and allows the surgery to be done with less assistance. We present a case of a femoral trochlea lesion following the placement of a reamed suprapatellar intramedullary nail for fixation of a tibial shaft fracture. Case Presentation:An active 33-year-old male with no prior history of knee pain sustained a distal tibial shaft fracture and was treated with suprapatellar intramedullary nail fixation. Five months later, he underwent revision surgery with exchange nail placement and reaming via an infrapatellar technique for delayed healing of the fracture with subsequent successful healing. The patient, otherwise healthy, continued to experience persistent anterior knee pain with clunking and inability to arise from a flexed knee position approximately 18 months post-surgery. Magnetic resonance imaging and arthroscopic evaluation of the joint were performed, and a full-thickness cartilage lesion was identified in the central portion of the femoral trochlear groove. Conclusion: The purpose of the present case is to bring awareness to the fact that the suprapatellar approach to intramedullary nailing tibial shaft fracture fixation can be accompanied by trochlear articular cartilage damage, which can be successfully treated with cartilage restoration.

Suprapatellar vs infrapatellar approaches for intramedullary nailing of distal tibial fractures: a systematic review and meta-analysis

“…Up to 71% of patients receiving IP nailing complain of anterior knee pain, especially in the kneeling position, possibly due to patellar tendon or infrapatellar nerve violation, no matter whether the paratendinous or transtendinous method is used [ 20 ]. Although the reamers repeatedly go back and forth within the patellofemoral joint during the SP procedure, carrying risks of cartilage damage [ 21 ], the related complications were not reported in our enrolled studies and should be preventable by using a protection sleeve. Chan et al [ 22 ] reported that three out of 11 patients had patellofemoral articular changes found by arthroscopic exam immediately after nailing, but none experienced related joint pain at 12 months follow-up.…”