Outcomes for a custom-made anchor-like plate combined with cerclage in the treatment of inferior pole patellar fracture

Surgical treatment of inferior pole fractures of the patella: a systematic review

PURPOSE

This study aimed to comprehensively review the existing evidence concerning surgical treatment of inferior pole fractures of the patella and to report the outcomes and complications of different fixation techniques.

METHOD

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches of PubMed, Scopus, and Web of Science were conducted in March 2023. Studies were screened against predecided inclusion and exclusion criteria. The extracted data included fracture characteristics, surgical techniques, and radiographic and functional outcomes. The Methodological Index for Non-Randomized Studies (MINORS) quality assessment tool was used to assess the eligible literature. The primary outcome was postoperative range of motion of different surgical methods, and the secondary outcomes were other clinical results and complications.

RESULTS

A total of 42 studies satisfied all the inclusion criteria and were deemed suitable for review. Fourteen case-control studies and 28 case series were selected, for a total of 1382 patients with a mean age of 51.0 years (range = 11-90). The follow-up period ranged from 6 to 300 months. The surgical techniques were categorized based on the device used as follows: (1) rigid fixation device; (2) tensile fixation device; (3) mixed device; and (4) extra-patella device.

CONCLUSION

Regarding the outcomes following surgical treatment of inferior pole fractures of the patella, the postoperative range of motion (ROM) of each technique ranged from 120° to 135°, with the exception of that involving the patellotibial wire which had poorer outcomes. The lowest functional score was also found in those using the patellotibial wire. Complications after surgery are rare, but approximately half of the patients required additional surgery for implant removal, particularly those whose initial surgery involved rigid fixation devices. It's worth noting that bony fragment excision is no longer recommended, and the combined use of multiple surgical devices is now more common.

Treatment of proximal patellar tendon rupture with custom-made anchor-like plate and suture: cases report and literature review

We reported 2 cases of patellar tendon rupture at the lower pole of the patella. For patellar tendon rupture, simple suture fixation has been proved to be inadequate in strength. Our center uses custom-made anchor-like plate and suture to treat proximal patellar fracture. The fixation strength is reliable, no additional bone tunnel is required, and the fixation of the lower patellar fracture can be achieved at the same time. After the operation, the patient starts functional exercise of the knee joint at an early stage, The function of the knee joint of the patient recovered well after 1 year, without other complications.

Tension-band wiring through a single cannulated screw combined with suture anchors to treat inferior pole fracture of the patella

PURPOSE

To evaluate the feasibility and clinical outcomes of tension-band wiring through a single cannulated screw combined with two suture anchors in treating inferior pole fracture of the patella.

METHODS

Between September 2018 and September 2021, a total of 22 patients with a mean age of 55 years who sustained inferior pole fracture of the patella and were treated by tension-band wiring through a single cannulated screw combined with two suture anchors were enrolled. X-ray radiographs were performed to observe the bone union time. The duration of each operation was recorded to reflect the complexity of surgical treatment. Functional measurements, comprising range of motion (ROM), the Böstman scale, and the Knee Injury and Osteoarthritis Outcome Score (KOOS), were taken. Postoperative complications including fixation failure, incision infection, loss of reduction, and malunion were evaluated.

RESULTS

All patients were followed up for an average of 17 months (range: 12-25 months). The average clinical bone union time was 8 weeks (range: 6-12 weeks), and the radiographic bone union time was 11 weeks (range: 8-12 weeks). At the final follow-up, the mean ROM was 136° (range: 115°-140°), the KOOS was 85 (range: 68-100) and the Böstman score was 28 (range: 20-30); these outcomes were classified as excellent in 17 cases and good in 5 cases, with no instances of poor results. Loss of reduction occurred in one case, while no cases of incision infection, fixation failure or malunion were observed.

CONCLUSION

For inferior pole fracture of the patella, tension-band wiring through a single cannulated screw combined with suture anchors can offer sufficient fixation stability to achieve a satisfactory clinical outcome with reduced operational complexity; this procedure should be recommended in clinical practice.

Design and Validation of a Smile-Necklace Plate for Treating Inferior Patellar Pole Avulsion Fractures: A Review and Hypothesis

The patella's inferior pole transmits force generated by contraction of the quadriceps muscle to the tibial tuberosity through the attached patellar ligament, thus completing knee extension. Therefore, fractures of the patella's inferior pole disrupt the coherence of mechanical transmission in the lower extremities. There appears to be no consensus among trauma centers regarding the treatment of infrapatellar pole fractures, primarily because there is no consistent design or application of internal fixation for this type of fracture. We designed a new internal implant similar to the smile necklace based on our previous study. This smile‐necklace plate (SNP) has the advantage of both plate fixation and tension‐band wiring fixation, permitting early rehabilitation, especially in osteoporotic comminuted infrapatellar pole fractures. Finite element analysis helped verify the biomechanical advantages of the SNP in comparison with existing studies. Hence, this novel implant is a promising treatment option for inferior pole patellar fractures.