Anterior knee pain and functional outcome following different surgical techniques for tibial nailing: a systematic review

Abstract

Purpose The aim of this systematic review was to compare knee pain and function after tibial nail insertion through an infrapatellar, semi-extended and suprapatellar technique. Methods A search was carried out to identify articles with an exact description of the method used for insertion of the tibial nail and description of the outcome parameters (knee pain or function). Data on study design, population, rate and severity of anterior knee pain and function scores were extracted. Pooled rates and scores were calculated. Results 67 studies with 3,499 patients were included. The pooled rate of patients with anterior knee pain was 38% (95% CI 32–44) after nail insertion through an infrapatellar approach and 10% (95% CI 1–26) after insertion through a suprapatellar approach. Pooled analysis was not possible for the semi-extended technique. Knee pain scores as measured by visual analogue score (0–10) ranged from 0.2 (95% CI − 0.1–0.5) for general knee pain to 3.7 (95% CI 1.3–6.1) for pain during kneeling. Pooled estimates for the Lysholm score were 87 points (range 77–97) for the infrapatellar technique and 85 points (range 82–85) for the suprapatellar technique. Iowa Knee scores were 94 (range 86–96) and Anterior Knee Pain Scale scores were 76 (range 75–80) after infrapatellar nail insertion. Discussion Depending on the technique used, the proportion of patients with knee pain after tibial nailing varied between 10 and 38%. The actual measured knee pain scores were, however, surprisingly low. Knee function was good for both the infra- and suprapatellar technique.

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

“…El número de estudios primarios identificados por cada revisión en particular varió de 16 a 67. La revisión con el mayor número de estudios incluidos [10] tenía 67 de 75 artículos (89%) que eran elegibles. Se exploró si esta revisión excluyó explícitamente estos estudios o si hubo criterios adicionales que explicaran por qué no se incluyeron.…”

“…Se encontraron cuatro revisiones sistemáticas [9,10,11,12], que incluyen en total setenta y cinco estudios primarios (principalmente ensayos clínicos aleatorizados y algunos estudios observacionales) descritos en dos publicaciones [10,11]. ¿Cuál es la población?…”

“…Los dos ensayos clínicos incluyeron a pacientes adultos que tuvieron una fractura de tibia y que fueron sometidos a tratamiento quirúrgico de IMN, ya sea suprapatelar o infrapatelar. En uno de estos [10] se incluyó a pacientes mayores de 18 años y en el segundo de ellos [11] la edad media fue de 40 (en pacientes con intervención suprapatelar) y 41 años (en pacientes con IMN infrapatelar).…”

Outcome of tibial shaft fractures treated with the SIGN FIN nail at Addis Ababa Emergency, Burn, and Trauma Hospital (AaEBT) Addis Ababa, Ethiopia

“…In this study, there was only one patient with anterior knee pain and tenderness, but anterior knee pain was one of the commonly listed complications of antegrade nailing with a reported incidence of 31%–69%. 31…”

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

“…The suprapatellar (SP) approach was developed to overcome these difficulties. The semi-extended position of the leg means the limb is adequately supported without the need for ongoing manual maintenance of reduction as well as simple positioning and use of the image intensifier, overall leading to a more efficient operation without compromising the outcome [ 4 , 5 ].…”