Suture repair of patellar inferior pole fracture: Transosseous tunnel suture compared with anchor suture

Abstract

Patellar inferior pole fracture is difficult to treat due to the inherent weakness of small comminuted distal fragments. However, suture fixation was recently introduced and reported. The aim of the present study was to evaluate and compare the clinical outcomes of two suture techniques, transosseous tunnel suture (TTS) and anchor suture (AS), for the fixation of patellar inferior pole fracture. A total of 35 patients with patellar inferior pole fracture treated at the Second Affiliated Hospital of Nanchang University (Nanchang, China) between June 2014 and April 2018 were retrospectively reviewed. Of these, 14 were treated with the TTS technique and 21 using AS fixation. The operation time, incision length and total cost were determined and compared. Functional outcomes were analyzed with the visual analog scale (VAS), Bostman and Lysholm scores and knee joint ranges of motion (ROMs). Postoperative complications were also observed and recorded. The mean follow-up was 22.6±9.7 and 18.7±5.9 months for TTS and AS, respectively. The groups were similar regarding age, sex, operative side and time to surgery. A smaller incision length and shorter operation time but higher hospital costs were observed in the AS group (P<0.01). For functional evaluation, there was no significant difference in VAS, Bostman and Lysholm scores or ROM between the 2 groups (P>0.05). No postoperative complications were observed in the TTS group. Only one patient in the AS group experienced a superficial minor wound infection. The TTS and AS techniques provided similarly satisfactory clinical outcomes for treating patellar inferior pole fracture. TTS had the advantage of cost-effectiveness due to saving anchors, while AS had a shorter operation time and a smaller incision length.

Efficacy comparison of Kirschner-wire tension band combined with patellar cerclage and anchor-loop plate in treatment of inferior patellar pole fracture

“…However, when applied to the inferior-pole fracture of the patella, it may easily lead to the failure of internal fixation ( Zhu et al, 2020 ). Partial resection of the patella and reconstruction of the patellar ligament may affect the patella’s short and long axes and affect the patellofemoral joint’s function in the treatment of inferior-pole fracture of the patella ( Huang et al, 2021 ). Comparatively better outcomes have been achieved by the fixation of displaced fragments ( Veselko and Kastelec, 2005 ; Matejcić et al, 2008 ).…”

Surgical treatment of inferior pole fractures of the patella: a systematic review

“…1C) [5, 7, 10, 20, 33, 38, 42, 43, 45], TOR with or without partial patellectomy ( n = 238, 11 studies; Fig. 1D) [1, 2, 12, 14, 15, 17, 18, 21, 29, 31, 47], and SA ( n = 133, 6 studies; Fig. 1E) [14, 17, 19, 35, 41, 45].…”

“…1D ) [2, 3, 6, 8, 16, 22, 26, 35, 41, 44, 46, 48], suture anchors (SA; Fig. 1E ) [14, 17, 19, 26], and transosseous reattachment (TOR; Fig. 1F) with or without partial patellectomy [1, 2, 12, 14, 15, 17, 18, 21, 29, 31, 37, 47].…”

“…1E ) [14, 17, 19, 26], and transosseous reattachment (TOR; Fig. 1F) with or without partial patellectomy [1, 2, 12, 14, 15, 17, 18, 21, 29, 31, 37, 47]. Additional techniques frequently used for augmentation include the use of cerclage wiring ( Fig.…”

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

“…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 23 . The use of wire anchors also requires careful evaluation in patients with osteoporosis, especially concerning the timing of functional exercise and early weight‐bearing 24 …”