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Anterior knee pain following the lateral parapatellar approach for tibial nailing

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Anterior knee pain after intramedullary nailing of tibial shaft fractures is a common clinical problem, with various etiologies. We have used a lateral parapatellar approach with atraumatic elevation of the infrapatellar fat pad to expose the starting point. Our hypothesis was that this approach leads to a low incidence of knee pain.

Methods

We conducted a retrospective study of 78 patients suffering from tibia fractures treated by a single surgeon. Fifty patients were available for the study. All fractures were fixed with a reamed intramedullary nail using the modified lateral approach. Complaints of knee pain and range of motion as well as keeling ability were examined in the clinic visit and recorded in the patients’ charts. Lysholm knee scores were collected following the last follow-up visit. Average follow-up was 13 months (range 6–26 months).

Results

Nine patients (19%) had subjective anterior knee pain when directly questioned. Eighty-two percentage of patients had no difficulty kneeling and this was significantly correlated with lack of knee pain. Good or excellent knee scores were reported by 92% of patients. Average knee flexion was 130°. There was a negative correlation between the presence of open fracture and outcome. No correlation was found between knee pain and nail insertion depth or coronal alignment.

Conclusion

The modified lateral parapatellar approach with careful dissection of the fat pad may significantly reduce anterior knee pain after intramedullary nailing of the tibial shaft.

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Authors and Affiliations

  1. Orthopaedic Trauma Service, The Hospital for Special Surgery, New York, NY, USA

    Yoram A. Weil, Michael J. Gardner, Sreevathsa Boraiah, David L. Helfet & Dean G. Lorich

  2. Orthopaedic Trauma Service, Hadassah Hebrew University Medical Center, Ein-Karem, POB 1200, 91120, Jerusalem, Israel

    Yoram A. Weil

Authors
  1. Yoram A. Weil
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  2. Michael J. Gardner
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  3. Sreevathsa Boraiah
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  4. David L. Helfet
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  5. Dean G. Lorich
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Corresponding author

Correspondence to Yoram A. Weil.

Additional information

Research Funding (per all authors): No financial project support of this research project occurred Financial Disclosure (per all authors): We have received nothing of value. Device status: the device that is the subject of this manuscript is FDA approved.

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Weil, Y.A., Gardner, M.J., Boraiah, S. et al. Anterior knee pain following the lateral parapatellar approach for tibial nailing. Arch Orthop Trauma Surg 129, 773–777 (2009). https://doi.org/10.1007/s00402-008-0678-7

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  • DOI: https://doi.org/10.1007/s00402-008-0678-7

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