Comparative Study of Knee Function and Pain Between the Suprapatellar and Medial Parapatellar Approaches After Intramedullary Nailing of a Tibial Fracture
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Published:
Apr 18, 2022
Keywords:
Tibia fracture, tibia nailing, semi-extended approach, suprapatellar approach, parapatellar approach
Main Article Content
Abstract
Introduction: Anterior knee pain is the most frequent cause of reoperation after intramedullary nailing of a tibial fracture. In recent years, semiextension approaches have simplified the surgical technique, but postoperative pain continues to be the most frequent complication. The aim of this study is to compare the medial parapatellar approach (PPM) vs the suprapatellar approach (SP) with respect to knee pain and postoperative function after intramedullary tibial nailing.
Materials and Methods: We retrospectively formed 2 groups of patients with tibial fractures treated with intramedullary nailing through the PPM (n:33) and SP (n:17) approaches. We evaluated postoperative knee pain with the VAS and Lysholm score; and function with the SF-12. They were clinically evaluated at 1, 3, 6 and 12 months.
Results: The mean age of the groups was 41.5 years (29-76) for the PPM group and 40.4 years (23-90) for the SP group. Pain and knee function were significantly better in the group of patients operated through the SP approach.
Conclusion: The suprapatellar approach is associated with less knee pain and better postoperative function after intramedullary nailing of a tibial fracture. However, prospective studies should validate these results.
Materials and Methods: We retrospectively formed 2 groups of patients with tibial fractures treated with intramedullary nailing through the PPM (n:33) and SP (n:17) approaches. We evaluated postoperative knee pain with the VAS and Lysholm score; and function with the SF-12. They were clinically evaluated at 1, 3, 6 and 12 months.
Results: The mean age of the groups was 41.5 years (29-76) for the PPM group and 40.4 years (23-90) for the SP group. Pain and knee function were significantly better in the group of patients operated through the SP approach.
Conclusion: The suprapatellar approach is associated with less knee pain and better postoperative function after intramedullary nailing of a tibial fracture. However, prospective studies should validate these results.
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How to Cite
Pereira, S., Alzate Munera, M., Nasello, T. I., & Bidolegui, F. (2022). Comparative Study of Knee Function and Pain Between the Suprapatellar and Medial Parapatellar Approaches After Intramedullary Nailing of a Tibial Fracture. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(2), 177-181. https://doi.org/10.15417/issn.1852-7434.2022.87.2.1405
Section
Clinical Research
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References
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PMID: 7744927
2. Donald G, Seligson D. Treatment of tibial shaft fractures by percutaneous Kuntscher nailing. Technical difficulties and a review of 50 consecutive cases. Clin Orthop Relat Res 1983;(178):64-73. PMID: 6883869
3. Wennergren D, Bergdahl C, Selse A, Ekelund J, Sundfeldt M, Möller M. Treatment and reoperation rates in one
thousand and three hundred tibial fractures from the Swedish Fracture Register. Eur J Orthop Surg Traumatol
2021;31(1):143-54. https://doi.org/10.1007/s00590-020-02751-x
4. Katsoulis E, Court-Brown C, Giannoudis PV. Incidence and aetiology of anterior knee pain after intramedullary
nailing of the femur and tibia. J Bone Joint Surg Br 2006;88(5):576-80. https://doi.org/10.1302/0301-620X.88B5.16875
5. Sanders RW, DiPasquale TG, Jordan CJ, Arrington JA, Sagi HC. Semiextended intramedullary nailing of the tibia
using a suprapatellar approach: radiographic results and clinical outcomes at a minimum of 12 months follow-up. J Orthop Trauma 2014;28(5):245-55. https://doi.org/10.1097/BOT.0000000000000082
6. Rothberg DL, Stuart AR, Presson AP, Haller JM, Higgins TF, Kubiak EN. A comparison of the open semi-extended
parapatellar versus standard entry tibial nailing techniques and knee pain: a randomized controlled trial. J Orthop Trauma 2019;33(1):31-6. https://doi.org/10.1097/BOT.0000000000001309
7. Ozcan C, Turkmen I, Sokucu S. Comparison of three different approaches for anterior knee pain after tibia
intramedullary nailing. Eur J Trauma Emerg Surg 2020;46(1):99-105. https://doi.org/10.1007/s00068-018-0988-6
8. Bakhsh WR, Cherney SM, McAndrew CM, Ricci WM, Gardner MJ. Surgical approaches to intramedullary nailing
of the tibia: Comparative analysis of knee pain and functional outcomes. Injury 2016;47(4):958-61.
https://doi.org/10.1016/j.injury.2015.12.025
9. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis one use of a scoring scale. Am J Sports Med 1982;10(3):150-4. https://doi.org/10.1177/036354658201000306
10. Ware J, Kosinski M, Keller S. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34(3):220-33. https://doi.org/10.1097/00005650-199603000-00003
11. Mochida H, Kikuchi S. Injury to infrapetallar branch of saphenous nerve in arthroscopic knee surgery. Clin Orthop Relat Res 1995;(320):88-94. PMID: 7586847
12. Poehling GG, Pollock EE Jr, Koman LA. Reflex sympathetic dystrophy of the knee after sensory nerve injury.
Arthroscopy 1988;4(1):31-5. https://doi.org/10.1016/s0749-8063(88)80008-2
13. Sala F, Binda M, Lovisetti G. Anterior gonalgic syndrome after intramedullary nailing: ultrasound and radiologic study. Chir Organi Mov 1998;83(3):271-5. PMID: 10052235
14. Bhattacharyya T, Seng K, Nassif NA, Freedman I. Knee pain after tibial nailing: the role of nail prominence. Clin Orthop Relat Res 2006;(449):303-7. https://doi.org/10.1097/01.blo.0000223976.91089.08
15. Gaines RJ, Rockwood J, Garland J, Ellingsorn C, Demaio M. Comparison of insertional trauma between
suprapatellar and infrapatellar portals for tibial nailing. Orthopedics 2013;36(9):e1155-8.
https://doi.org/10.3928/01477447- 20130821-17
16. Zamora R, Wright C, Short A, Seligson D. Comparison between suprapatellar and parapatellar approaches for
intramedullary nailing of the tibia. Cadaveric study. Injury 2016;47(10):2087-90.
https://doi.org/10.1016/j.injury.2016.07.024
17. MacDonald DRW, Caba-Doussoux P, Carnegie CA, Escriba I, Forward DP, Graf M, et al. Tibial nailing using
a suprapatellar rather than an infrapatellar approach significantly reduces anterior knee pain postoperatively: a
multicentre clinical trial. Bone Joint J 2019;101B(9):1138-43. https://doi.org/10.1302/0301-620x.101b9.bjj-2018-1115.r2
18. Gelbke MK, Coombs D, Powell S, DiPasquale TG. Suprapatellar versus infra- patellar intramedullary nail insertion of the tibia: a cadaveric model for comparison of patellofemoral contact pressures and forces. J Orthop Trauma 2010;24:665-71. https://doi.org/10.1097/BOT.0b013e3181f6c001
PMID: 7744927
2. Donald G, Seligson D. Treatment of tibial shaft fractures by percutaneous Kuntscher nailing. Technical difficulties and a review of 50 consecutive cases. Clin Orthop Relat Res 1983;(178):64-73. PMID: 6883869
3. Wennergren D, Bergdahl C, Selse A, Ekelund J, Sundfeldt M, Möller M. Treatment and reoperation rates in one
thousand and three hundred tibial fractures from the Swedish Fracture Register. Eur J Orthop Surg Traumatol
2021;31(1):143-54. https://doi.org/10.1007/s00590-020-02751-x
4. Katsoulis E, Court-Brown C, Giannoudis PV. Incidence and aetiology of anterior knee pain after intramedullary
nailing of the femur and tibia. J Bone Joint Surg Br 2006;88(5):576-80. https://doi.org/10.1302/0301-620X.88B5.16875
5. Sanders RW, DiPasquale TG, Jordan CJ, Arrington JA, Sagi HC. Semiextended intramedullary nailing of the tibia
using a suprapatellar approach: radiographic results and clinical outcomes at a minimum of 12 months follow-up. J Orthop Trauma 2014;28(5):245-55. https://doi.org/10.1097/BOT.0000000000000082
6. Rothberg DL, Stuart AR, Presson AP, Haller JM, Higgins TF, Kubiak EN. A comparison of the open semi-extended
parapatellar versus standard entry tibial nailing techniques and knee pain: a randomized controlled trial. J Orthop Trauma 2019;33(1):31-6. https://doi.org/10.1097/BOT.0000000000001309
7. Ozcan C, Turkmen I, Sokucu S. Comparison of three different approaches for anterior knee pain after tibia
intramedullary nailing. Eur J Trauma Emerg Surg 2020;46(1):99-105. https://doi.org/10.1007/s00068-018-0988-6
8. Bakhsh WR, Cherney SM, McAndrew CM, Ricci WM, Gardner MJ. Surgical approaches to intramedullary nailing
of the tibia: Comparative analysis of knee pain and functional outcomes. Injury 2016;47(4):958-61.
https://doi.org/10.1016/j.injury.2015.12.025
9. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis one use of a scoring scale. Am J Sports Med 1982;10(3):150-4. https://doi.org/10.1177/036354658201000306
10. Ware J, Kosinski M, Keller S. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34(3):220-33. https://doi.org/10.1097/00005650-199603000-00003
11. Mochida H, Kikuchi S. Injury to infrapetallar branch of saphenous nerve in arthroscopic knee surgery. Clin Orthop Relat Res 1995;(320):88-94. PMID: 7586847
12. Poehling GG, Pollock EE Jr, Koman LA. Reflex sympathetic dystrophy of the knee after sensory nerve injury.
Arthroscopy 1988;4(1):31-5. https://doi.org/10.1016/s0749-8063(88)80008-2
13. Sala F, Binda M, Lovisetti G. Anterior gonalgic syndrome after intramedullary nailing: ultrasound and radiologic study. Chir Organi Mov 1998;83(3):271-5. PMID: 10052235
14. Bhattacharyya T, Seng K, Nassif NA, Freedman I. Knee pain after tibial nailing: the role of nail prominence. Clin Orthop Relat Res 2006;(449):303-7. https://doi.org/10.1097/01.blo.0000223976.91089.08
15. Gaines RJ, Rockwood J, Garland J, Ellingsorn C, Demaio M. Comparison of insertional trauma between
suprapatellar and infrapatellar portals for tibial nailing. Orthopedics 2013;36(9):e1155-8.
https://doi.org/10.3928/01477447- 20130821-17
16. Zamora R, Wright C, Short A, Seligson D. Comparison between suprapatellar and parapatellar approaches for
intramedullary nailing of the tibia. Cadaveric study. Injury 2016;47(10):2087-90.
https://doi.org/10.1016/j.injury.2016.07.024
17. MacDonald DRW, Caba-Doussoux P, Carnegie CA, Escriba I, Forward DP, Graf M, et al. Tibial nailing using
a suprapatellar rather than an infrapatellar approach significantly reduces anterior knee pain postoperatively: a
multicentre clinical trial. Bone Joint J 2019;101B(9):1138-43. https://doi.org/10.1302/0301-620x.101b9.bjj-2018-1115.r2
18. Gelbke MK, Coombs D, Powell S, DiPasquale TG. Suprapatellar versus infra- patellar intramedullary nail insertion of the tibia: a cadaveric model for comparison of patellofemoral contact pressures and forces. J Orthop Trauma 2010;24:665-71. https://doi.org/10.1097/BOT.0b013e3181f6c001