Tibial nailing using a suprapatellar rather than an infrapatellar approach significantly reduces anterior knee pain postoperatively: a multicentre clinical trial

Macdonald, David R.; Caba-Doussoux, Pedro; Carnegie, C.; Escribá, I.; Forward, D. P.; Graf, Matthias; Johnstone, Alan J.

doi:10.1302/0301-620x.101b9.bjj-2018-1115.r2

Cited by 51 publications

(61 citation statements)

References 28 publications

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“…This study demonstrated that the VAS pain score was significantly lower in the SP group than in the IP group. This finding is consistent with the finding observed in a multicenter clinical trial conducted by MacDonald et al who compared the VAS scores between the IP and SP approaches in 95 patients and demonstrated that the SP IMN surgical approach is associated with lower postoperative anterior knee pain than that associated with the IP IMN surgical approach [19]. A recent meta-analysis indicated that the SP approach was associated with a significant reduction in the VAS scores [17].…”

Section: Discussionsupporting

confidence: 90%

Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

Wang²,

Ren

et al. 2020

J Orthop Surg Res

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Background This study aimed to analyze and compare the clinical and functional outcomes of distal tibia fractures treated with intramedullary nailing (IMN) using the suprapatellar (SP) and infrapatellar (IP) surgical approaches. Methods A retrospective analysis was performed in 63 patients with distal fractures that were treated with IMN between August 2014 and August 2018. A total of 27 and 36 patients underwent IMN using the SP and IP techniques, respectively. The surgical time, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications were reviewed in this study. Anterior knee pain was assessed using the visual analog scale. The Lysholm Knee Scoring Scale and American Orthopaedic Foot and Ankle Society (AOFAS) scale were used as clinical measurements. Results A total of 63 patients, with a minimum follow-up of 12 months, were evaluated. The average surgical time, blood loss, rate of adjuvant reduction technique, closed reduction rate, fracture healing time, and Lysholm Knee Scoring Scale score were insignificantly different (P > 0.05) between the two groups. However, the SP approach was superior to the IP approach in terms of pain score, AOFAS score, and fracture deformity rate (P < 0.05). Conclusions In the treatment of distal tibia fractures, the SP IMN technique is associated with a significantly higher functional outcome, lower knee pain, and lower rate of fracture deformity than the IP IMN technique.

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Section: Discussionsupporting

confidence: 90%

Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

Wang²,

Ren

et al. 2020

J Orthop Surg Res

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“…This study demonstrated that the VAS pain score was signi cantly lower in the SP group than in the IP group. This nding is consistent with the nding observed in a multicenter clinical trial conducted by MacDonald et al who compared the VAS scores between the IP and SP approaches in 95 patients and demonstrated that the SP IMN surgical approach is associated with lower postoperative anterior knee pain than that associated with the IP IMN surgical approach [19]. A recent meta-analysis indicated that the SP approach was associated with a signi cant reduction in the VAS scores [17].…”

Section: Discussionsupporting

confidence: 89%

Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

Wang

et al. 2020

Preprint

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Background: This study aimed to analyze and compare the clinical and functional outcomes of distal tibia fractures treated with intramedullary nailing (IMN) using the suprapatellar (SP) and infrapatellar (IP) surgical approaches.Methods: A retrospective analysis was performed in 63 patients with distal fractures that were treated with IMN between August 2014 and August 2018. A total of 27 and 36 patients underwent IMN using the SP and IP techniques, respectively. The surgical time, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications were reviewed in this study. Anterior knee pain was assessed using the visual analog scale. The Lysholm Knee Scoring Scale and American Orthopaedic Foot and Ankle Society (AOFAS) scale were used as clinical measurements.Results: A total of 63 patients, with a minimum follow-up of 12 months, were evaluated. The average surgical time, blood loss, rate of adjuvant reduction technique, closed reduction rate, fracture healing time, and Lysholm Knee Scoring Scale score were insignificantly different (P>0.05) between the two groups. However, the SP approach was superior to the IP approach in terms of pain score, AOFAS score, and fracture deformity rate (P<0.05).Conclusions: In the treatment of distal tibia fractures, the SP IMN technique is associated with a significantly higher functional outcome, lower knee pain, and lower rate of fracture deformity than the IP IMN technique.

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“…The majority of the RCTs have low risk of bias in terms of randomisation, allocation concealment, incomplete outcome data and selective outcome reporting, whereas some studies demonstrated high levels of bias in terms of blinding of participants and outcome assessment [7,15,21]. The risk of bias graph and summary are displayed in Figs.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…The median follow up time periods for each study ranged from 9 months to 50.4 months. Post-operative knee function was assessed with the Lysholm knee score in four studies [7,15,21,23]. the Hospital for Special Knee Surgery Score (HSS) in 2 studies [17,20], Kujala Knee Score in 2 studies [19,23] and Oxford Knee Score (OKS) in one study [16].…”

Section: Characteristics Of Studies Includedmentioning

confidence: 99%

“…Post-operative knee function was assessed with the Lysholm knee score in four out of eight studies [7,15,21,23], and the results show that there is moderate heterogeneity with better functional outcomes in SP group at 12 months. The studies with outcomes of HSS score, Kujala score, and Oxford knee score were unable to show any superiority of SP group (Fig.…”

Section: Outcome 4: Knee Functional Scoresmentioning

confidence: 99%

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Infrapatellar versus suprapatellar approach for intramedullary nailing of the tibia: a systematic review and meta-analysis

et al. 2021

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Background Intramedullary nailing (IMN) is a conventional technique for the treatment of tibial shaft fractures. It has been suggested that the suprapatellar (SP) approach holds advantages over the traditional infrapatellar (IP) approach. Current literature lacks adequate data to provide robust clinical recommendations. This meta-analysis aims to determine the efficacy of infrapatellar versus suprapatellar techniques for IMN. Methods An up-to-date literature search of the Embase, Medline, and registry platform databases was performed. The search was conducted using a predesigned search strategy and all eligible literature was critically appraised for methodological quality via the Cochrane’s collaboration tool. Fluoroscopy time, operative time, pain score, knee function, deep infection, non-union and secondary operation rates were all considered. Conclusion A total of twelve studies were included in the meta-analysis. The results of this analysis show that suprapatellar nailing is associated with reduced post-operative pain scores and improved functional outcomes. The data suggest no significant difference in terms of operative times, fluoroscopy times, rates of deep infection, non-union or secondary procedures when compared to infra-patellar techniques. Further studies are required to confirm these findings and assess long-term results.

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Tibial nailing using a suprapatellar rather than an infrapatellar approach significantly reduces anterior knee pain postoperatively: a multicentre clinical trial

Cited by 51 publications

References 28 publications

Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

Infrapatellar versus suprapatellar approach for intramedullary nailing of the tibia: a systematic review and meta-analysis

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