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


METHODS
Therapeutic Level III.
Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv, 64239, Israel. Assafkadar@hotmail.com.|Department of Orthopaedic Surgery, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel. Assafkadar@hotmail.com.
Assaf
A
Kadar
Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv, 64239, Israel.
Haggai
H
Sherman
Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv, 64239, Israel.|Department of Orthopaedic Surgery, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
Michael
M
Drexler
Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv, 64239, Israel.
Eldad
E
Katz
Orthopedic Division, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv, 64239, Israel.|Department of Orthopaedic Surgery, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
Ely L
EL
Steinberg
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010329:Patella / Q000293:injuries / Q000601:surgery*; D011183:Postoperative Complications; D011788:Quality of Life; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D053441:Suture Anchors; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult
Anchor; Complications; Outcomes; Patella distal pole; Patellar fracture; Revision rate