Toivanen, J Bone Joint Surg Am 2002 - Anterior Knee Pain after Intramedullary Nailing of Fractures of the Tibial Shaft

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Anterior Knee Pain after Intramedullary Nailing of Fractures of the Tibial Shaft

Toivanen, Järvinen, et al.·J Bone Joint Surg Am·2002·232 citations·RCT

Background

Anterior knee pain is the most common complication after intramedullary nailing of the tibia. Dissection of the patellar tendon and its sheath during nailing is thought to be a contributing cause of chronic anterior knee pain. The purpose of this prospective, randomized study was to assess whether the prevalence or the intensity of anterior knee pain following intramedullary nailing of a tibial shaft fracture is reduced by the use of a paratendinous incision for the nail entry portal.

Methods

50 patients with a tibial shaft fracture requiring intramedullary nailing were randomized equally to treatment with paratendinous or transtendinous nailing.
21 patients from both study groups were followed for an average of 3 years after nailing.
After fracture union, all but 2 patients had elective nail removal through the same surgical approach as was used for the nailing.
At the follow-up evaluation, the patients used visual analog scales to report their level of anterior knee pain and the impairment caused by that pain.
The scales described by Lysholm and Gillquist and by Tegner et al., the Iowa knee scoring system, and simple functional tests were used to quantitate the functional results.
Isokinetic thigh-muscle strength was also measured.

Results

14 (67%) of the 21 patients treated with transtendinous nailing reported anterior knee pain at the final evaluation.
Of these 14 patients, 13 were mildly to severely impaired by the pain.
15 (71%) of the 21 patients treated with paratendinous nailing reported anterior knee pain, and 10 of the 15 were impaired by the pain.
The Lysholm, Tegner, and Iowa knee scoring systems; muscle-strength measurements; and functional tests showed no significant differences between the 2 groups.

Conclusions

Compared with a transpatellar tendon approach, a paratendinous approach for nail insertion does not reduce the prevalence of chronic anterior knee pain or functional impairment by a clinically relevant amount after intramedullary nailing of a tibial shaft fracture.

Copyright remains with the authors and publisher.

Anterior Knee Pain after Intramedullary Nailing of Fractures of the Tibial Shaft

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Anterior Knee Pain after Intramedullary Nailing of Fractures of the Tibial Shaft

Toivanen, Järvinen, et al.·J Bone Joint Surg Am·2002·232 citations·RCT

Background

Anterior knee pain is the most common complication after intramedullary nailing of the tibia. Dissection of the patellar tendon and its sheath during nailing is thought to be a contributing cause of chronic anterior knee pain. The purpose of this prospective, randomized study was to assess whether the prevalence or the intensity of anterior knee pain following intramedullary nailing of a tibial shaft fracture is reduced by the use of a paratendinous incision for the nail entry portal.

Methods

50 patients with a tibial shaft fracture requiring intramedullary nailing were randomized equally to treatment with paratendinous or transtendinous nailing.
21 patients from both study groups were followed for an average of 3 years after nailing.
After fracture union, all but 2 patients had elective nail removal through the same surgical approach as was used for the nailing.
At the follow-up evaluation, the patients used visual analog scales to report their level of anterior knee pain and the impairment caused by that pain.
The scales described by Lysholm and Gillquist and by Tegner et al., the Iowa knee scoring system, and simple functional tests were used to quantitate the functional results.
Isokinetic thigh-muscle strength was also measured.

Results

14 (67%) of the 21 patients treated with transtendinous nailing reported anterior knee pain at the final evaluation.
Of these 14 patients, 13 were mildly to severely impaired by the pain.
15 (71%) of the 21 patients treated with paratendinous nailing reported anterior knee pain, and 10 of the 15 were impaired by the pain.
The Lysholm, Tegner, and Iowa knee scoring systems; muscle-strength measurements; and functional tests showed no significant differences between the 2 groups.

Conclusions

Compared with a transpatellar tendon approach, a paratendinous approach for nail insertion does not reduce the prevalence of chronic anterior knee pain or functional impairment by a clinically relevant amount after intramedullary nailing of a tibial shaft fracture.

Copyright remains with the authors and publisher.

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