Patellar fractures are associated with an increased risk of total knee arthroplasty

Abstract

Aims The aim of this study was to investigate the incidence of knee arthroplasty and arthroscopy following patellar fractures, and to compare this with an age- and gender-matched group without a prior patellar fracture. Patients and Methods A national matched cohort study based on the Danish National Patient Register including all citizens of Denmark (approximately 5.3 million) was undertaken. A total of 6096 patients who sustained a patellar fracture in Denmark between 1 January 1996 and 31 December 2000 were included. The median age of these patients was 50.6 years (interquartile range (IQR) 28.5 to 68.9); 49.1% were women. Patients were followed-up until 31 December 2015, with regard to treatment with knee arthroplasty and/or knee arthroscopy. Results Patients with a patellar fracture had an increased risk of knee arthroplasty (hazard ratio (HR) 1.83, 95% confidence interval (CI) 1.57 to 2.13) compared with citizens without a patellar fracture, and the effect was strongest during the first five years (HR 3.02, 95% CI 2.26 to 4.03). Patients with a patellar fracture also had a higher risk of knee arthroscopy (HR 3.94, 95% CI 3.49 to 4.46), and the effect was highest during the first five years after the fracture (HR 7.40, 95% CI 6.32 to 8.66). Conclusion Patellar fractures are associated with an increased risk of knee arthroplasty and knee arthroscopy. The consequences of a patellar fracture may be more severe than previously considered, and patients must expect a lifelong increased risk of knee arthroplasty. Cite this article: Bone Joint J 2018;100-B:1477–81.

Anterior Locking Plate Osteosynthesis of Patellar Factures – Analysis of Complications and Functional Outcome

“…Das Hauptziel der operativen Versorgung ist die stufenlose Wiederherstellung der retropatellaren Gelenkfläche, da eine verbleibende Inkongruenz das Risiko einer frühzeitigen posttraumatischen Retropatellararthrose erhöht [8]. Des Weiteren sollte eine übungsstabile Osteosynthese erzielt werden, um eine frühfunktionelle Nachbehandlung zu ermöglichen und damit das Risiko einer Kniegelenkteilsteife zu reduzieren [7].…”

“…The main goal in surgical treatment is the reconstruction of a smooth retropatellar articular surface because any residual incongruity increases the risk of early posttraumatic retropatellar osteoarthritis 8 . Moreover, the goal was to achieve patellar fixation stable enough for early physiotherapy to reduce the risk of impaired knee joint ROM 7 .…”

Evolution in the Management of Patella Fractures

“…Transverse patella fractures (AO 34-C1) account for 23% of all patellar fractures. Numerous biomechanical studies have assessed fixation using tension band wire (TBW) in this fracture pattern, and TBW is widely regarded as the gold standard for this ‘simple’ fracture pattern (see Figure 1 ) [ 5 , 43 , 44 , 45 , 46 , 47 ].…”

“…Wagner et al compared locking plates and cannulated screws with tension band wiring (TBW) through the screws. The hybrid group, consisting of a cannulated lag screw and TBW, showed statistically significant higher displacement than the locking plate group after 100 cycles [ 5 , 80 ]. During cyclic loading, five out of the eight hybrid constructs failed, while all constructs in the plate osteosynthesis group withstood the test fixation stress.…”

“…Patellar fractures exhibit a bimodal age distribution, occurring more frequently in a younger age group with higher energy trauma and a second peak in older age due to osteoporotic fractures [ 4 ]. The most common types of multi-fragmentary fractures, namely AO (Arbeitsgemeinschaft für Osteosynthesefragen) type 34-C3 and 34-C1, are associated with high-energy trauma, representing 25% and 23% of all patellar fractures, respectively [ 4 , 5 , 6 ].…”