COMPARATIVE ANALYSIS OF ANTERIOR KNEE PAIN IN TRANSPATELLAR AND MEDIAL PARAPATELLAR TENDON APPROACHES IN TIBIAL INTERLOCKING NAILING
Abstract
Background: Anterior knee pain is the most common complaint after intramedullary nail of the tibia.The incidence of anterior knee pain ranges from 10–86% and the exact ethology is unclear. Transpatellar tendon approach is commonly used for tibial intramedullary interlocking nailing but it can also be done through medial parapatellar tendon approach. The objective of the study was to compare post-operative anterior knee pain after intramedullary nailing technique by transpatellar approach compared to medial parapatellar approach. Methods: This randomized controlled trial was carried out in Department of Orthopaedic and Spine Surgery, Ghurki trust teaching hospital, Lahore from 20th February to 19th Nov 2015. Sixty patients who presented at emergency department for the treatment of simple tibial shaft fractures were included in the study. They were divided into two groups with 30 patients in each group, Group A containing patients operated through transpatellar tendon approach while group B containing patients operated through medial parapatellar tendon approach. Results: In Group A, 27 patients were male and 3 patients were female with a mean age of 28.667±9.63 while in Group B, 28 were male and 2 were female with a mean age of 34.63±15.82. The main cause of tibial shaft fractures were RTA followed by fall. In Group A mean anterior knee pain was 4.4 while in Group B, it was was 2.5 with a p value of .000. Conclusion: This study shows that medial parapatellar tendon approach causes less pain as compared to transpatellar approach. Keywords: Tibial shaft fractures; Transpatellar Approach; Medial parapatellar Approach; Intra-medullary nailingReferences
Sadeghpour A, Mansour R, et al. Comparison of trans patellar approach and medial parapatellar tendon approach in tibial intramedullary nailing for treatment of tibial fractures. JPMA 2011;61:530-533
Vaseenon T, Luevitoonvechkij S, Akkaraatimart W and Laohapoonrungsee A. Accurate Entry Point for Tibial Nailing with SIGN Nail in Asians: A Cadaveric Study. J Trauma Treat 2012;1:1-3.
Chakraborty MK, Thapa P, Sathian B. Surgical Implant Generation Network (SIGN) Solid Intramedullary Interlocking Nail in the Lower Extremity: An Observational Study from Western Nepal. J Clin and Diagn Resea, December 2011;5: 1614-1617.
Canale ST, Beaty JH. Campbell's operative Orthopaedics.12th Ed. New York: Mosby: 2013;2650-2657.
Khan I, Javed S, Khan GN and Aziz A. Outcome of Intramedullary Interlocking SIGN Nail in Tibial Diaphyseal Fracture. Journal of the College of Physicians and Surgeons Pakistan 2013;23(3): 203-207
Keating, J. F. Invited Commentary Anterior Knee Pain After Intramedullary Nailing of the Tibia: Biomechanical Effects of the Nail Entry Zone and Anterior Cortical Bone Loss. Journal of Orthopaedic Trauma: January 2013; 27(1): 41–42
Ramos T, Eriksson B, Karisson J, Nistor L. Ilizarov external fixation or locked intramedullary nailing in diaphyseal tibial fractures: a randomized, prospective study of 58 consecutive patients. Arch Orthop Truama Surg 2014;134:793-802
Solomon L, Warwick D, Nayagam S. Injuries of knee and leg. Apley’s System of Orthopaedics and Fractures 9th Edition 2010: 897-904.
Tahririan MA, Ziae E, Osanloo R. Significance of the position of the proximal tip of the tibial nail: An important factor related to anterior knee pain. Adv Biomed Res 2014;3:119.
. Pedro José Labronici, Robinson Esteves Santos Pires,José Sérgio Franco, Hélio Jorge Alvachian Fernandes and Fernando Baldy dos Reis ,Recommendations for avoiding knee pain after intramedullary nailing of tibial shaft fractures,. Patient Safety in Surgery 2011, 5:31
Gyaneshwar Tonk, Gaurav Menwal, Amit Kumar Gupta, Nitesh Rustagi, Alok Kumar. Anterior Knee Pain in Transtendinous and Paratendinous Approaches of Tibial Interlocking Nail: A Comparative Study. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 28, July 14; Page: 7874-7880
Väistö O, Toivanen J, Kannus P, Järvinen M. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft: an eight-year follow-up of a prospective, randomized study comparing two different nail-insertion techniques. J Trauma 2008;64:1511-6
Yavuz et al. Comparison of intramedullary nail and plate fixation in distal tibia diaphyseal fractures close to the mortise, Ulus Travma Acil Cerrahi Derg, May 2014, Vol. 20, No. 3
Fanian et al, Anterior knee pain after unreamed intramedullary nailing of the tibia,JRMS 2008; 13(5): 260-2631. Sadeghpour A, Mansour R, Aghdam HA, Goldus M. Comparison of trans patellar approach and medial parapatellar tendon approach in tibial intramedullary nailing for treatment of tibial fractures. J Pak Med Assoc 2011;61(6):530–3.
Vaseenon T, Luevitoonvechkij S, Akkaraatimart W, Laohapoonrungsee A. Accurate Entry Point for Tibial Nailing with SIGN Nail in Asians: A Cadaveric Study. J Trauma Treat 2012;1:1–5.
Chakraborty MK, Thapa P, Sathian B. Surgical Implant Generation Network (SIGN) Solid Intramedullary Interlocking Nail in the Lower Extremity: An Observational Study from Western Nepal. J Clin Diagn Resea 2011;5(8):1614–7.
Canale ST, Beaty JH. Campbell's operative Orthopaedics.12th Ed. New York: Mosby: 2013;2650–7.
Khan I, Javed S, Khan GN, Aziz A. Outcome of Intramedullary Interlocking SIGN Nail in Tibial Diaphyseal Fracture. J Coll Physicians Surg Pak 2013;23(3):203–7.
Keating JF. Invited Commentary Anterior Knee Pain After Intramedullary Nailing of the Tibia: Biomechanical Effects of the Nail Entry Zone and Anterior Cortical Bone Loss. J Orthop Trauma 2013;27(1):41–2.
Ramos T, Eriksson B, Karisson J, Nistor L. Ilizarov external fixation or locked intramedullary nailing in diaphyseal tibial fractures: a randomized, prospective study of 58 consecutive patients. Arch Orthop Truama Surg 2014;134(6):793–802.
Nayagam S. Injuries of knee and leg. In: Solomon L, Warwick D, Nayagam S, editors. Apley’s System of Orthopaedics and Fractures. 9th ed. London: Hodder Arnold; 2010. P.875–908.
Tahririan MA, Ziae E, Osanloo R. Significance of the position of the proximal tip of the tibial nail: An important factor related to anterior knee pain. Adv Biomed Res 2014;3:119.
Labronici PJ, Santos Pires RE, Franco JS, Alvachian Fernandes HJ, Dos Reis FB. Recommendations for avoiding knee pain after intramedullary nailing of tibial shaft fractures. Patient Saf Surg 2011;5(1):31.
Tonk G, Menwal G, Gupta AK, Rustagi N, Kumar A. Anterior Knee Pain in Transtendinous and Paratendinous Approaches of Tibial Interlocking Nail: A Comparative Study. J Evol Med Dent Sci 2014;3(28):7874–80.
Väistö O, Toivanen J, Kannus P, Järvinen M. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft: an eight-year follow-up of a prospective, randomized study comparing two different nail-insertion techniques. J Trauma 2008;64(6):1511–6.
Yavuz U, Sökücü S, Demir B, Yıldırım T, Ozcan C, Kabukçuoğlu YS. Comparison of intramedullary nail and plate fixation in distal tibia diaphyseal fractures close to the mortise, Ulus Travma Acil Cerrahi Derg 2014;20(3):189–93.
Fanian H, Dehghani M, Anterior knee pain after unreamed intramedullary nailing of the tibia. J Res Med Sci 2008;13(5):260–3.
Song SY, Chang HG, Byun JC, Kim TY. Anterior Knee Pain After Tibial Intramedullary Nailing Using A Medial Paratendinous Approach. J Orthop Trauma 2012;26(3):172–7.
Darabos N, Bajs ID, Rutić Z, Darabos A, Poljak D, Dobsa J. Nail position has an influence on anterior knee pain after tibial intramedullary nailing. Coll Antropol 2011;35(3):873–7.
Leliveld MS, Verhofstad MH. Injury to the infrapatellar branch of the saphenous nerve, a possible cause for anterior knee pain after tibial nailing? Injury 2012;43(6):779–83.
Labronici PJ, Santos Pires RE, Franco JS, Alvachian Fernandes HJ, Dos Reis FB. Recommendations for avoiding knee pain after intramedullary nailing of tibial shaft fractures. Patient Saf Surg 2011;5(1):31.
Jankovic A, Korac Z, Bozic NB, Stedu I. Influence of knee flexion and atraumatic mobilisation of infrapatellar fat pad on incidence and severity of anterior knee pain after tibial nailing. Injury 2013;44(3):S33–9.
Downloads
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
