Effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in treatment of patellar inferior pole fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Xin ,  YUAN Jianmin , DING Guozheng , MA Nengfeng , CHENG Wenjing

Department of Traumatic Orthopaedics, the First Affiliated Hospital of Wannan Medical College, Wuhu Anhui, 241000, P. R. China;

Corresponding?author：

YUAN Jianmin, Email: yjianmin5286856@163.com

Keywords：

Patellar inferior pole fracture; suture anchor; Nice knot; inernal fixation

DOI：

10.7507/1002-1892.202302040

Video：

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Objective To investigate effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in the treatment of patellar inferior pole fractures. Methods A clinical data of 37 patients with unilateral patellar inferior pole fracture who met the selection criteria between June 2017 and June 2021 was retrospectively analyzed. Among them, 17 cases were treated with the suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling (group A), and 20 cases were treated with the traditional Kirschner wire tension band technique (group B). There was no significant difference in terms of gender, age, body mass index, fracture side, combined medical disease, and preoperative hemoglobin between the two groups (P>0.05). Operation time, intraoperative blood loss, postoperative complications, fracture healing time, knee range of motion, and knee function Bostman score (range of motion, pain, daily work, muscle atrophy, walking aids, knee effusion, soft leg, and stair climbing) and grading were recorded in both groups at last follow-up. Results There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). All incisions healed by first intention. All patients were followed up 1-2 years, with an average of 1.7 years. X-ray films reexamination showed that all fractures in group A healed, while 2 cases in group B did not heal. There was no significant difference in bone healing time between the two groups (P>0.05). At last follow-up, the knee range of motion, the range of motion score of Bostman score, total score and effectiveness grading in group A were significantly better than those in group B (P<0.05). There was no significant difference in the other items of Bostman scores between the two groups (P>0.05). During follow-up, 2 cases of internal fixation failure and 1 case of internal fixator irritation occurred in group B, and no complication related to internal fixation occurred in group A. The occurrence of complications was significantly lower in group A than in group B (P<0.05). Conclusion Compared with the traditional Kirschner wire tension band technique, the suture anchor combined with Nice knot strapping via longitudinal patellar drilling for the patellar inferior pole fractures has the advantages of simple operation, reliable fixation, early flexion and extension activity, and better functional recovery of knee joint.

Citation： ZHANG Xin, YUAN Jianmin, DING Guozheng, MA Nengfeng, CHENG Wenjing. Effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in treatment of patellar inferior pole fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(6): 675-680. doi: 10.7507/1002-1892.202302040 Copy

1.	陳曉斌, 張建政, 劉智, 等. 髕骨骨折的治療進展. 中國骨傷, 2018, 31(10): 885-888.
2.	Matejci? A, Puljiz Z, Elabjer E, et al. Multifragment fracture of the patellar apex: basket plate osteosynthesis compared with partial patellectomy. Arch Orthop Trauma Surg, 2008, 128(4): 403-408.
3.	Pandey AK, Pandey S, Pandey P. Results of partial patellectomy. Arch Orthop Trauma Surg, 1991, 110(5): 246-249.
4.	劉晨東, 胡孫君, 張世民. 髕骨下極骨折手術治療進展. 中國修復重建外科雜志, 2023, 37(1): 115-119.
5.	Krkovic M, Bombac D, Balazic M, et al. Modified pre-curved patellar basket plate, reconstruction of the proper length and position of the patellar ligament-a biomechanical analysis. Knee, 2007, 14(3): 188-193.
6.	Kim KS, Suh DW, Park SE, et al. Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: suture bridge anchor fixation technique. Arch Orthop Trauma Surg, 2021, 141(11): 1889-1897.
7.	袁建敏, 陶周善, 楊民, 等. 帶線錨釘聯合髕骨橫向鉆孔修復股四頭肌腱骨腱結合部斷裂. 中國骨傷, 2020, 33(1): 71-75.
8.	B?stman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
9.	Gwinner C, M?rdian S, Schwabe P, et al. Current concepts review: Fractures of the patella. GMS Interdiscip Plast Reconstr Surg DGPW, 2016, 5: Doc01. doi: 10.3205/iprs000080.
10.	Kadar A, Sherman H, Drexler M, et al. Anchor suture fixation of distal pole fractures of patella: twenty seven cases and comparison to partial patellectomy. Int Orthop, 2016, 40(1): 149-154.
11.	Yan SG, Li D, Cui Y, et al. Management of comminuted inferior patellar pole fractures with cerclage-wire-augmented separate vertical wiring: a retrospective clinical study. Arch Orthop Trauma Surg, 2023, 143(1): 247-254.
12.	Egol K, Howard D, Monroy A, et al. Patella fracture fixation with suture and wire: you reap what you sew. Iowa Orthop J, 2014, 34: 63-67.
13.	Anand A, Kumar M, Kodikal G. Role of suture anchors in management of fractures of inferior pole of patella. Indian J Orthop, 2010, 44(3): 333-335.
14.	許福生, 夏平, 程安源, 等. 間斷垂直縫合固定髕骨下極粉碎性骨折. 中國矯形外科雜志, 2022, 30(22): 2087-2089.
15.	Seggewiss J, Nicolini LF, Lichte P, et al. Transosseous suture versus suture anchor fixation for inferior pole fractures of the patella in osteoporotic bone: a biomechanical study. Eur J Med Res, 2022, 27(1): 270. doi: 10.1186/s40001-022-00903-9.
16.	Patel VR, Parks BG, Wang Y, et al. Fixation of patella fractures with braided polyester suture: a biomechanical study. Injury, 2000, 31(1): 1-6.
17.	O’Donnell R, Lemme NJ, Marcaccio S, et al. Suture anchor versus transosseous tunnel repair for inferior pole patellar fractures treated with partial patellectomy and tendon advancement: A biomechanical study. Orthop J Sports Med, 2021, 9(8): 23259671211022245. doi: 10.1177/23259671211022245.
18.	Gao Z, Long N, Yao K, et al. A novel technique for the treatment of inferior pole fractures of the patella: A preliminary report. Orthop Surg, 2022, 14(11): 3092-3099.
19.	王攀峰, 章云童, 夏琰, 等. 兩種內固定方法治療髕骨下極粉碎性骨折的病例對照研究. 中國骨傷, 2021, 34(10): 920-924.
20.	王海鵬, 梁立卓, 王璞, 等. 髕骨下極骨折: 一種新的微創治療方法及其臨床療效分析. 創傷外科雜志, 2022, 24(8): 596-601.

1. 陳曉斌, 張建政, 劉智, 等. 髕骨骨折的治療進展. 中國骨傷, 2018, 31(10): 885-888.
2. Matejci? A, Puljiz Z, Elabjer E, et al. Multifragment fracture of the patellar apex: basket plate osteosynthesis compared with partial patellectomy. Arch Orthop Trauma Surg, 2008, 128(4): 403-408.
3. Pandey AK, Pandey S, Pandey P. Results of partial patellectomy. Arch Orthop Trauma Surg, 1991, 110(5): 246-249.
4. 劉晨東, 胡孫君, 張世民. 髕骨下極骨折手術治療進展. 中國修復重建外科雜志, 2023, 37(1): 115-119.
5. Krkovic M, Bombac D, Balazic M, et al. Modified pre-curved patellar basket plate, reconstruction of the proper length and position of the patellar ligament-a biomechanical analysis. Knee, 2007, 14(3): 188-193.
6. Kim KS, Suh DW, Park SE, et al. Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: suture bridge anchor fixation technique. Arch Orthop Trauma Surg, 2021, 141(11): 1889-1897.
7. 袁建敏, 陶周善, 楊民, 等. 帶線錨釘聯合髕骨橫向鉆孔修復股四頭肌腱骨腱結合部斷裂. 中國骨傷, 2020, 33(1): 71-75.
8. B?stman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
9. Gwinner C, M?rdian S, Schwabe P, et al. Current concepts review: Fractures of the patella. GMS Interdiscip Plast Reconstr Surg DGPW, 2016, 5: Doc01. doi: 10.3205/iprs000080.
10. Kadar A, Sherman H, Drexler M, et al. Anchor suture fixation of distal pole fractures of patella: twenty seven cases and comparison to partial patellectomy. Int Orthop, 2016, 40(1): 149-154.
11. Yan SG, Li D, Cui Y, et al. Management of comminuted inferior patellar pole fractures with cerclage-wire-augmented separate vertical wiring: a retrospective clinical study. Arch Orthop Trauma Surg, 2023, 143(1): 247-254.
12. Egol K, Howard D, Monroy A, et al. Patella fracture fixation with suture and wire: you reap what you sew. Iowa Orthop J, 2014, 34: 63-67.
13. Anand A, Kumar M, Kodikal G. Role of suture anchors in management of fractures of inferior pole of patella. Indian J Orthop, 2010, 44(3): 333-335.
14. 許福生, 夏平, 程安源, 等. 間斷垂直縫合固定髕骨下極粉碎性骨折. 中國矯形外科雜志, 2022, 30(22): 2087-2089.
15. Seggewiss J, Nicolini LF, Lichte P, et al. Transosseous suture versus suture anchor fixation for inferior pole fractures of the patella in osteoporotic bone: a biomechanical study. Eur J Med Res, 2022, 27(1): 270. doi: 10.1186/s40001-022-00903-9.
16. Patel VR, Parks BG, Wang Y, et al. Fixation of patella fractures with braided polyester suture: a biomechanical study. Injury, 2000, 31(1): 1-6.
17. O’Donnell R, Lemme NJ, Marcaccio S, et al. Suture anchor versus transosseous tunnel repair for inferior pole patellar fractures treated with partial patellectomy and tendon advancement: A biomechanical study. Orthop J Sports Med, 2021, 9(8): 23259671211022245. doi: 10.1177/23259671211022245.
18. Gao Z, Long N, Yao K, et al. A novel technique for the treatment of inferior pole fractures of the patella: A preliminary report. Orthop Surg, 2022, 14(11): 3092-3099.
19. 王攀峰, 章云童, 夏琰, 等. 兩種內固定方法治療髕骨下極粉碎性骨折的病例對照研究. 中國骨傷, 2021, 34(10): 920-924.
20. 王海鵬, 梁立卓, 王璞, 等. 髕骨下極骨折: 一種新的微創治療方法及其臨床療效分析. 創傷外科雜志, 2022, 24(8): 596-601.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in treatment of patellar inferior pole fracture

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