Anterior Knee Pain in Transtendinous and Paratendinous Approaches of Tibial Interlocking Nail: A Comparative Study

Abstract

BACKGROUND:Anterior knee pain has been described as the most common complication after intramedullary nailing of fracture shaft of tibia. Dissection of the patellar tendon and its sheath during transtendinous nailing is thought to be as one of the contributing causes of chronic anterior knee pain. The purpose of this prospective, randomized study was to compare the incidence of anterior knee pain after intramedullary nailing of a tibial shaft fracture with transtendinous and paratendinous incision technique. MATERIAL AND METHODS: From April 2012 to October 2013 eighty patients with closed tibial shaft fractures were admitted and treated in our institution. Patients were randomized for treatment with paratendinous or transtendinous nailing (as 24 patients did not complete their follow up or were lost in follow up, so 56 patients were analyzed finally). For assessment we used visual analogue scales to report the level of anterior knee pain. The scales described by Lysholm and Gillquist and by Tegner et al., were also used to quantitate the functional results. RESULTS: 12 of the 28 (42%) patients treated with transtendinous nailing. reported anterior knee pain whereas 8 patients out of 28 (28%), in which paratendinous technique was used had persistent anterior knee pain after minimum final follow up of 24 weeks, with no significant statistical difference. The Lysholm, Tegner functional scoring systems showed a significant difference between the two groups. CONCLUSION: Compared with a transtendinous approach, a paratendinous approach for nail insertion does not reduce the incidence of chronic anterior knee pain or functional impairment after intramedullary nailing of a tibial shaft fracture. In long term, anterior knee pain seems to disappear from many patients. Since our study is small and have short duration of follow up, further larger studies and long duration of follow up is needed to establish the results.

Clinical Outcome of Tibia Intramedullary Nailing Using Suprapatellar Portal

“…When parapatellar approach is used, the patellar tendon, the retropatellar fat pad and the tissues are retracted and, theoretically there would be no tissue injury. [13][14][15] Recent advances in nail design and reduction techniques have expanded the indications for intramedullary nail fixation to more proximal as well as more distal tibia fractures in volving the metaphyseal area. Techniques have been developed to insert the nail through a semi-extended suprapatellar approach to facilitate intraoperative imaging, allow easier access to starting site position, and counter deforming forces.…”