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Altered long-term health-related quality of life in patients following patella fractures: a long-term follow-up study of 49 patients

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Abstract

Introduction

The primary aim was to investigate the health-related quality of life (HRQOL) in patients treated for a patella fracture. The explorative aim was to report the associations between HRQOL, knee osteoarthritis, muscle strength and gait function.

Methods

The study design was a cohort study. Patients who were treated for patella fractures at Aalborg University Hospital, Denmark between January 2006 and December 2009 were identified. Patients between the age of 18 and 80 were included. The main outcome was assessed by the EQ5D–5L questionnaire. Classifications by Sperner and Kellgren/Lawrence were applied to evaluate osteoarthritis. Moreover, functional outcomes were evaluated by: KOOS, muscle strength and gait analysis.

Results

Forty-nine patients were included with a mean follow-up time of 8.5 years. The mean age was 53.9 years. The mean EQ5D–5L index value was 0.741, and was significantly worse compared to a reference population. X-rays taken at the time of diagnosis and the time of follow-up showed progression towards a higher degree of osteoarthritis in the injured knee for both the patellofemoral and tibiofemoral joints. Patients demonstrated significantly lower knee extension strength in the injured leg compared to the non-injured leg (P = 0.011). No significant difference in gait speed and cadence were observed compared to the reference population. Knee osteoarthritis, muscle strength and gait patterns were not associated with HRQOL (R < 0.35).

Conclusion

At 8.5 years following a patella fracture, HRQOL was significantly worse compared to an age-matched reference population.

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References

  1. Court-Brown CM. Rockwood and Green’s fractures in adults. Walters Kluwer, USA. 2015.

  2. Larsen P, Court-Brown CM, Vedel JO, Vistrup S, Elsoe R. Incidence and epidemiology of patellar fractures. Orthopedics. 2016;39:e1154–e8.

    Article  Google Scholar 

  3. Shabat S, Mann G, Kish B, Stern A, Sagiv P, Nyska M. Functional results after patellar fractures in elderly patients. Arch Gerontol Geriatr. 2003;37:93–8.

    Article  Google Scholar 

  4. Eggink KM, Jaarsma RL. Mid-term (2–8 years) follow-up of open reduction and internal fixation of patella fractures: does the surgical technique influence the outcome? Arch Orthop Trauma Surg. 2011;131:399–404.

    Article  Google Scholar 

  5. Benli IT, Akalin S, Mumcu EF, Citak M, Kilic M, Pasaoglu E. The computed tomographic evaluation of patellofemoral joint in patellar fractures treated with open reduction and internal fixation. Kobe J Med Sci. 1992;38:233–43.

    CAS  PubMed  Google Scholar 

  6. Boström Å. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl A. Bostrom; 1972, pp. 1–80.

  7. Edwards B, Johnell O, Redlund-Johnell I. Patellar fractures. A 30-year follow-up. Acta Orthop Scand. 1989;60:712–4.

    Article  CAS  Google Scholar 

  8. Jaskulka R, Ittner G, Raffezeder U. Surgical management of dislocated patellar fractures—therapy and results. Unfallchirurgie. 1989;15:253–60.

    CAS  PubMed  Google Scholar 

  9. Kölndorfer G, Boszotta H, Prunner K, Helperstorfer W. Long-term results after surgical treatment of patellar fractures. Conservative techniques versus resection. Unfallchirurgie. 1994;20:37–41.

    Article  Google Scholar 

  10. Levack B, Flannagan JP, Hobbs S. Results of surgical treatment of patellar fractures. J Bone Joint Surg Br. 1985;67:416–9.

    Article  CAS  Google Scholar 

  11. Sanderson MC. The fractured patella: a long term follow up study. Aust N Z J Surg. 1975;45:49–54.

    Article  CAS  Google Scholar 

  12. Sperner G, Wanitschek P, Benedetto KP, Glotzer W. G. S, P. W, et al. Late complications after patella fractures. Aktuelle Traumatol. 1990;20:24–8.

    CAS  PubMed  Google Scholar 

  13. Anand S, Hahnel JCR, Giannoudis PV. Open patellar fractures: high energy injuries with a poor outcome? Injury. 2008;39:480–4.

    Article  Google Scholar 

  14. LeBrun CT, Langford JR, Sagi HC. Functional outcomes after operatively treated patella fractures. J Orthop Trauma. 2012;26:422–6.

    Article  Google Scholar 

  15. Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl. 1972;143:1–80.

    Article  Google Scholar 

  16. Larsen P, Laessoe U, Rasmussen S, Graven-Nielsen T, Berre Eriksen C, Elsoe R. Asymmetry in gait pattern following tibial shaft fractures—a prospective one-year follow-up study of 49 patients. Gait Posture. 2016;51:47–51.

    Article  Google Scholar 

  17. Thingstad P, Taraldsen K, Saltvedt I, Sletvold O, Vereijken B, Lamb SE, et al. The long-term effect of comprehensive geriatric care on gait after hip fracture: the Trondheim Hip Fracture Trial—a randomised controlled trial. Osteoporos Int. 2016;27:933–42.

    Article  CAS  Google Scholar 

  18. Warschawski Y, Elbaz A, Segal G, Norman D, Haim A, Jacov E, et al. Gait characteristics and quality of life perception of patients following tibial plateau fracture. Arch Orthop Trauma Surg. 2015;135:1541–6.

    Article  Google Scholar 

  19. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12:1495–9.

    Article  Google Scholar 

  20. Questionnary E-5d. Eq-5d questionnary. http://www.euroqol.org/about-eq-5d/publications/user-guide.html. Accessed June 2016.

  21. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–43.

    Article  CAS  Google Scholar 

  22. Sorensen J, Davidsen M, Gudex C, Pedersen KM, Bronnum-Hansen H, Sørensen J, et al. Danish EQ-5D population norms. Scand J Public Health. 2009;37:467–74.

    Article  Google Scholar 

  23. KOOS questionnary [KOOS web site]. http://www.koos.nu. Accessed June 2016.

  24. Paradowski PT, Bergman S, Sunden-Lundius A, Lohmander LS, Roos EM. Knee complaints vary with age and gender in the adult population. Population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS). BMC Musculoskelet Disord. 2006;7:38.

    Article  Google Scholar 

  25. Colton C, Gebhard F, Kregor P, Oliver C. AO Classification of Patella Fractures [Internet]. AO Found. 2008 [cited 2016 Oct 7]. https://www2.aofoundation.org/wps/portal/surgery?showPage=diagnosis&bone=Knee&segment=Patella. Accessed June 2016.

  26. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502.

    Article  CAS  Google Scholar 

  27. Rathleff CR, Baird WN, Olesen JL, Roos EM, Rasmussen S, Rathleff MS. Hip and knee strength is not affected in 12–16 year old adolescents with patellofemoral pain—a cross-sectional population-based study. PLoS One. 2013;8:e79153.

    Article  Google Scholar 

  28. Parmar V, Shyam Kumar AJ, Harper WM. Reliability of the GAITRite walkway system for the quantification of temporo-spatial parameters of gait in young and older people. Gait Posture. 2006;23:523.

    Article  Google Scholar 

  29. Kuys SS, Brauer SG, Ada L. Test-retest reliability of the GAITRite system in people with stroke undergoing rehabilitation. Disabil Rehabil. 2011;33:1848–53.

    Article  Google Scholar 

  30. McDonough AL, Batavia M, Chen FC, Kwon S, Ziai J. The validity and reliability of the GAITRite system’s measurements: a preliminary evaluation. Arch Phys Med Rehabil. 2001;82:419–25.

    Article  CAS  Google Scholar 

  31. Yogev G, Plotnik M, Peretz C, Giladi N, Hausdorff JM. Gait asymmetry in patients with Parkinson’s disease and elderly fallers: when does the bilateral coordination of gait require attention? Exp Brain Res. 2007;177:336–46.

    Article  Google Scholar 

  32. Oberg T, Karsznia A, Oberg K. Basic gait parameters: reference data for normal subjects, 10–79 years of age. J Rehabil Res Dev. 1993;30:210–23.

    CAS  PubMed  Google Scholar 

  33. Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE. Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture. 2010;31:241–6.

    Article  Google Scholar 

  34. Larsen P, Lund H, Laessoe U, Graven-Nielsen T, Rasmussen S. Restrictions in quality of life after intramedullary nailing of tibial shaft fracture: a retrospective follow-up study of 223 cases. J Orthop Trauma. 2014;28:507–12.

    Article  Google Scholar 

  35. Volpin G, Dowd GSE, Stein H, Bentley G. Degenerative arthritis after intra-articular fractures of the knee. Br Editor Soc Bone Jt Surg. 1990;72–B:634–8.

    Article  Google Scholar 

  36. Woo J, Lau E, Lee P, Kwok T, Lau WCS, Chan C, et al. Impact of osteoarthritis on quality of life in a Hong Kong Chinese population. J Rheumatol Can. 2004;31:2433–8.

    Google Scholar 

  37. Bostrom A. Longitudinal fractures of the patella. Reconstr Surg Traumatol. 1974;14:136–46.

    CAS  PubMed  Google Scholar 

  38. Ziring E, Ishaque B, Ishaque N, Gotzen L. Fractures of the distal patella pole—treatment strategy and results. Acta Chir Austriaca. 2000. pp. 115–8.

  39. Ishaque B, Ziring E, Ishaque N, Petermann J, Gotzen L. Therapeutic concept and follow-up results after proximal avulsion injuries of patellar ligament and fractures of the distal patella pole. Unfallchirurgie. 1999. pp. 165–73.

  40. Perry MC, Carville SF, Smith ICH, Rutherford OM, Newham DJ. Strength, power output and symmetry of leg muscles: effect of age and history of falling. Eur J Appl Physiol. 2007;100:553–61.

    Article  Google Scholar 

  41. Larsen P, Laessoe U, Rasmussen S, Graven-Nielsen T, Berre Eriksen C, Elsoe R. Asymmetry in gait pattern following tibial shaft fractures - a prospective one-year follow-up study of 49 patients. Gait Posture. 2017;51:47–51.

    Article  Google Scholar 

  42. O’Shea MP, Teeling M, Bennett K. Comorbidity, health-related quality of life and self-care in type 2 diabetes: a cross-sectional study in an outpatient population. Ir J Med Sci. 2015;184:623–30.

    Article  Google Scholar 

  43. Holmes J, McGill S, Kind P, Bottomley J, Gillam S, Murphy M. Health-related quality of life in type 2 diabetes (T2ARDIS-2). Value Heal. 2000;3:S47–51.

    Article  Google Scholar 

  44. Singh JA, Tugwell P, Zanoli G, Wells GA. Total joint replacement surgery for knee osteoarthritis and other non-traumatic diseases: a network meta-analysis. Cochrane Database Syst Rev. 2015.

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Correspondence to P. Larsen.

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The authors have no conflicts of interest to report. The authors did not receive benefits or grants in any form from a commercial part related directly or indirectly to the subject of this article.

Ethical standards

This study was conducted in accordance with the ethical standards of the responsible committee and with the ethical principles of the 1975 Declaration of Helsinki. The Danish Data Protection Agency (Journal no. 2008-58-0028 ID 2016-115) and the Committee for Science Ethics of Northern Denmark (Journal no. N-20,160,030) approved the study.

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Vedel, J.O., Vistrup, S., Larsen, P. et al. Altered long-term health-related quality of life in patients following patella fractures: a long-term follow-up study of 49 patients. Eur J Trauma Emerg Surg 44, 707–716 (2018). https://doi.org/10.1007/s00068-017-0857-8

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  • DOI: https://doi.org/10.1007/s00068-017-0857-8

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