Low-profile fixation of an inferior pole patellar fracture using knotless suture anchors
Connor Sholtis1, Jeremy Truntzer2
1Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford; 2Department of Orthopedic Surgery, Palo Alto Veterans Affairs Medical Center, Palo Alto, CA, USA
Correspondence to: Connor Sholtis, https://orcid.org/0000-0001-8086-9053
Department of Orthopedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Building, R144, Stanford, CA 94305, USA. Tel: +1-650-721-7638, Fax: +1-650-721-3470, E-mail: csholtis@stanford.edu
Department of Orthopedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Building, R144, Stanford, CA 94305, USA. Tel: +1-650-721-7638, Fax: +1-650-721-3470, E-mail: csholtis@stanford.edu
Received July 21, 2024; Revised August 31, 2024; Accepted September 13, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
- Abstract
- Inferior pole patellar fractures with limited surface area for fixation are challenging events for surgeons. These fractures were historically treated by inferior pole resection and tendon repair; however, they are associated with increased patellofemoral contact forces. Surgical fixation involves tension band wiring, screw fixation, and plate fixation. Some studies have demonstrated increased risk of reoperation with metallic implants, leading to the recent popularity of suture-based fixation. Herein, we present a surgical technique using low-profile knotless suture anchors and transosseous tunnels for the treatment of an interior pole patellar fracture. This technique offers a reproducible method with a similar complication profile to suture-based techniques with the additional advantage of reduced suture bulk using a knotless mechanism and low-profile anchors.
- Keywords : Patella fracture; Suture techniques; Suture anchors
- References
- Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl 1972;143:1-80.
- Kastelec M, Veselko M. Inferior patellar pole avulsion fractures: osteosynthesis compared with pole resection. J Bone Joint Surg Am 2004;86:696-701.
- Hoshino CM, Tran W, Tiberi JV, et al. Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires. J Bone Joint Surg Am 2013;95:653-9.
- Edoardo M, Andrea DD, Silvia C, et al. Fixation of patella fractures with metallic implants is associated with a significantly higher risk of complications and re-operations than non-metallic implants: a systematic review and meta-analysis. Int Orthop 2022;46:2927-37.
- Chang CH, Chuang HC, Su WR, Kuan FC, Hong CK, Hsu KL. Fracture of the inferior pole of the patella: tension band wiring versus transosseous reattachment. J Orthop Surg Res 2021;16:365.
- Monaco E, Saithna A, Cardarelli S, et al. No difference in clinical and radiological outcomes following fixation of transverse patella fractures with either suture tape or metallic cerclage: a retrospective comparative study. Orthop Traumatol Surg Res 2022;108:103053.
- Noothan PT, Somashekara SA, Sunkappa SR, Karthik B, Rameshkrishnan K. A randomized comparative study of functional and radiological outcome of tension band wiring for patella fractures using SS wire versus fiberwire. Indian J Orthop 2023;57:876-83.
- Bric JD, Martin JM, McGrady LM, Wang M, Schmeling GJ. Biomechanical evaluation of transverse patella fracture fixation using headless screws: a comparison of suture versus cable as a tension band. J Orthop Trauma 2023;37:e253-7.
- 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;9:23259671211022245.
- Dy CJ, Little MT, Berkes MB, et al. Meta-analysis of re-operation, nonunion, and infection after open reduction and internal fixation of patella fractures. J Trauma Acute Care Surg 2012;73:928-32.
- Kumar G, Mereddy PK, Hakkalamani S, Donnachie NJ. Implant removal following surgical stabilization of patella fracture. Orthopedics 2010;33:301-4.
- Chen B, Wang Z, Qu X, et al. A novel suture bridge anchor fixation technique to treat inferior pole fractures of patella: a retrospective clinical study. Medicine (Baltimore) 2023;102:e34106.
- Kim KS, Suh DW, Park SE, Ji JH, Han YH, Kim JH. Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: suture bridge anchor fixation technique. Arch Orthop Trauma Surg 2021;141:1889-97.
- Xie J, Fu Y, Li J, Yu H, Zhang Y, Jing J. Anchor and Krackow-“8” suture for the fixation of distal pole fractures of the patella: comparison to Kirschner wire. Orthop Surg 2022;14:374-82.
- Li L, Bokshan SL, Ready LV, Owens BD. The primary cost drivers of arthroscopic rotator cuff repair surgery: a cost-minimization analysis of 40,618 cases. J Shoulder Elbow Surg 2019;28:1977-82.
- 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;27:270.
Full Text(PDF) Free
