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Anchor suture fixation of distal pole fractures of patella: twenty seven cases and comparison to partial patellectomy

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Abstract

Purpose

Partial patellectomy (PP) and reattachment of the patellar ligament with transosseous suturing is the mainstay of surgical treatment for distal pole patellar fractures. An anchor suturing (AS) technique has recently been reported as an alternative to PP in such fractures and allows for bone-to-bone interface and possibly superior fracture healing than bone-to-tendon interface with PP. We present our experience with AS and compare it to PP.

Methods

Between 2006 and 2011, 60 patients with distal pole patellar fracture underwent either AS (n = 27) or PP (n = 33). We retrospectively gathered their demographic data and information on fracture type, fixation technique, operation time, postoperative complications and knee range of motion. A telephone survey was performed to grade functional outcomes with standard questionnaires (the SF-12 for quality of life, the Kujala score for patellofemoral function and a visual analog scale [VAS] pain score).

Results

AS was equivalent to PP in terms of residual pain and functional outcomes (VAS: 2.45 vs. 2.26, p = 0.83 and Kujala score: 74.3 vs. 69, p = 0.351, respectively) as well as for knee range of motion. Complications included three cases of infection in each group, two cases of early hardware failure and one case of non-union in the AS group. Operation time was significantly shorter for AS compared to PP (68.5 vs. 79.1 min, p = 0.03).

Conclusions

AS is non-inferior to PP for function and pain after distal pole patellar fractures and is superior to PP with regard to operative time. Common complications of this technique are hardware failure and infections.

Level of evidence

Therapeutic Level III

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Acknowledgments

The authors would like to thank Dr. Isabella Karakis and Mrs. Yael Glazer for the statistical analysis and Ahuva Meilik, Mila Ozerski and Sivan Tzoref for data collection. Esther Eshkol is thanked for editorial assistance.

Conflict of interest and funding

All authors disclose that they have no financial and personal relationships with other people or organizations that could inappropriately influence this work. There were no external sources of funding for this study.

Ethics committee approval

This study was approved by the local ethics committee on January 2012 with approval number TLV-11-0585.

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Authors and Affiliations

  1. Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv, 64239, Israel

    Assaf Kadar, Haggai Sherman, Michael Drexler, Eldad Katz & Ely L. Steinberg

  2. Department of Orthopaedic Surgery, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel

    Assaf Kadar, Michael Drexler & Ely L. Steinberg

Authors
  1. Assaf Kadar
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  2. Haggai Sherman
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  3. Michael Drexler
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  4. Eldad Katz
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  5. Ely L. Steinberg
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Corresponding author

Correspondence to Assaf Kadar.

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Scientific conferences

This article has been presented at the Orthopaedic Trauma Association Annual Meeting, Tampa, FL, October, 2014, in the 33rd Annual Meeting of the Israel Orthopaedic Association, Tel Aviv, November, 2013 and will be presented at the 16th EFORT Congress, Prague, May, 2015.

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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. International Orthopaedics (SICOT) 40, 149–154 (2016). https://doi.org/10.1007/s00264-015-2776-9

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  • DOI: https://doi.org/10.1007/s00264-015-2776-9

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