Study: Suprapatellar nailing for tibial fracture may result in less anterior knee pain
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Key takeaways:
- Patients who underwent suprapatellar nailing had less anterior knee pain vs. patients who received infrapatellar nailing.
- Results of the study were statistically significant but not clinically significant.
SEATTLE — Patients with a tibial fracture experienced less postoperative anterior knee pain with suprapatellar nailing compared with infrapatellar nailing, according to data presented here.
“This is the largest and first appropriately powered randomized control trial powered to detect differences in anterior knee pain between infrapatellar and suprapatellar nailing,” David Cinats, MD, said in his presentation at the Orthopaedic Trauma Association Annual Meeting. “In conclusion, suprapatellar nailing resulted in less anterior knee pain with kneeling, although this was statistically but not clinically significant.”
Cinats and colleagues randomly assigned 254 patients with tibial fractures to receive either suprapatellar nailing or infrapatellar nailing. Outcomes measured included VAS after kneeling, Aberdeen Kneeling Test, Aberdeen Standing Test as well as patient-reported outcome measures to assess anterior knee pain.
“[The Aberdeen Kneeling Test] is a validated, patient-blinded weightbearing study where the patient kneels on two scales,” Cinats said. “The research coordinators then record for 60 seconds how much weight the patient can place through the knee, taking measurements every 15 seconds. The ratio was calculated by comparing the weight through both knees, injured leg to the uninjured leg, divided by the total body weight.”
After assessing VAS scores, Cinats said patients in the suprapatellar nailing group had significantly less anterior knee pain compared with the infrapatellar nailing group. He also said the two groups had no significant differences in Aberdeen Standing Test scores, complication rates, operative time, fluoroscopy time or patient-reported outcome measures.
In addition, he said patients in the suprapatellar group were able to bear significantly more weight than patients in the infrapatellar group during the Aberdeen Kneeling Test.
“Although we found a statistically significant difference in the VAS score after kneeling, which was our primary outcome, it did not reach our predetermined [minimal clinically important difference] MCID threshold of 1.6, meaning that these results are not clinically significant,” Cinats said.
“It is difficult to objectively assess anterior knee pain and perhaps an outcome test that stresses the suprapatellar and infrapatellar regions of the knee more equally would be more applicable,” he concluded.
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Cinats D, et al. Paper 84. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 18-21, 2023; Seattle.
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