Clinical Effect of Suture Anchor and Double-Pulley Technique in the Treatment of Inferior Patellar Fracture

Abstract

Objective. To evaluate the efficacy of suture anchor combined with double-pulley technique for subpatellar comminuted fractures compared with wire vertical suture and Krachow in the treatment of subpatellar fractures. Methods. Retrospectively selected 48 patients with subpatellar pole comminuted fracture admitted in our hospital from February 2013 to July 2019, 25 patients with double-pulley technique (group A), and 23 patients with vertical wire suture with Krachow suture. Patient age, gender, AT/OTA typing, injury mechanism, follow-up time, surgical time, bleeding volume, mean fracture healing time, and postoperative complications were recorded. The Insall-Salvati index immediately and 6 weeks after surgery. Bostman scores and knee activity were recorded at each follow-up, and month 12 was taken as the final result. Results. Time of surgery in group A (46.52 min) was significantly shorter than in group B (76.30 min). Intraoperative bleeding in group 15.1 ml, B, group 15.9 ml. Both incisions healed in stage I, averaging clinical healing of patella fracture within 10 weeks. There was no significant difference in mean Bostman score and knee activity at month 12 (group A: 28.4, 124.8°; group B: 28.1, 125.7°). There was no significant statistical difference in the Insall-Salvati index immediately or 6 weeks between the two groups. Group B patients had two wire fractures, fracture healing and the wire removed one year after surgery, and the remaining patients had no complications such as internal fixation loosening, fracture, delayed healing, or nonhealing of fracture. Conclusion. Compared with the treatment of subpatellar fracture with wire vertical suture and Krachow method, suture anchor with double-pulley technique has short operation time, reliable fixation, and less complications. Patients can have early functional exercise and good knee function recovery without secondary surgery. It can be considered as an alternative therapy for this fracture and deserves clinical adoption and promotion.

Comparison of Fixation Methods between Transosseous Pull-Out Suture and Separate Vertical Wiring for Inferior Pole Fracture of Patella: A Systematic Review and Meta-Analysis

“…None of the 16 identified studies performed a direct comparison between the KT and VW techniques. Eight studies 5,7,9,[15][16][17]27,28 involving 132 inferior pole fractures of the patella evaluated the results of the KT technique, while 8 studies 3,8,10,11,18,[29][30][31] involving 142 inferior fractures of the patella evaluated the results of the separate VW technique. All included studies had a minimum of 6 months of follow-up, and 9 5,8,11,15,17,18,[29][30][31] had a minimum of 1 year of follow-up (Table 1).…”

Design and Validation of a Smile‐Necklace Plate for Treating Inferior Patellar Pole Avulsion Fractures: A Review and Hypothesis

“…21 This procedure is minimally invasive, restores the anatomy of the knee extensor mechanism, and avoids the need for secondary surgery. 22 However, Kadar et al reported internal fixation failure due to limited fixation strength with wire anchors. The reoperation rate was 14.8%, with a high infection rate (11%), 19 Also, the placement of a wire anchor nail after partial resection of the inferior pole bone may decrease patellar height and cause misalignment.…”

“…The main principle is to bury a screw proximal to the patellar fracture, and then insert an anchor nail with its own tail wire through the patellar ligament to reposition the fracture and soft tissue at the lower pole of the patella and restore the original anatomical shape 21 . This procedure is minimally invasive, restores the anatomy of the knee extensor mechanism, and avoids the need for secondary surgery 22 . However, Kadar et al .…”

“… 21 This procedure is minimally invasive, restores the anatomy of the knee extensor mechanism, and avoids the need for secondary surgery. 22 However, Kadar et al . reported internal fixation failure due to limited fixation strength with wire anchors.…”

Tension band wiring versus suture anchor technique in patellar inferior pole fracture: Novel double row suture anchor technique

“…The primary goal of treating patellar inferior pole fractures is to restore the knee extension mechanism. Improper treatment of these fractures may result in the loss of the knee extension mechanism and patellofemoral joint coordination [ 4 , 5 ]. Therefore, anatomical reduction with strong internal fixation and early rehabilitation are important for patellar inferior pole fractures.…”