Superior Outcomes After Operative Fixation of Patella Fractures Using a Novel Plating Technique: A Prospective Cohort Study.
OBJECTIVE
The purpose of this prospective cohort study was to determine if a new patella fracture fixation construct resulted in improved outcomes compared with traditional tension band techniques.


METHODS
Comparative cohort study.


METHODS
Academic level I trauma center.


METHODS
Patients with isolated, unilateral patellar fractures were enrolled prospectively. From 2012 to 2014, 33 patients underwent fixation with a novel plate construct that spans half of the patella circumference laterally and provides multiplanar fixation through a low-profile plate. A comparison cohort was drawn from 25 patients treated from 2008 to 2012, where treatment consisted of traditional tension band fixation techniques.


METHODS
Surgical fixation of patella fractures was performed with either a tension band or novel plate construct.


METHODS
Subjective postoperative clinical outcomes and objective functional and strength measurements were subsequently collected.


RESULTS
The 2 cohorts had similar baseline characteristics. Patients with the plate construct had clinically and statistically significantly superior Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) scores throughout the study period (P < 0.001). Functional testing also demonstrated significant improvements in patients with plate constructs compared with tension band constructs at 12 months. Patients in the plate cohort had significantly increased thigh circumferences (P = 0.003) and decreased anterior knee pain (P < 0.0001) compared with the tension band cohort.


CONCLUSIONS
In this prospective cohort study, the use of a novel fixation construct with multiplanar and interfragmentary fixation and minimal disruption of patellar vascularity enables improved clinical outcomes and functional performance.


METHODS
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
*Orthopaedic Trauma Service, Hospital for Special Surgery and Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; †Pediatric Orthopaedic Service, Hospital for Special Surgery, New York, NY; ‡Department of Physical Therapy, New York Presbyterian Hospital, New York, NY; and §Orthopaedic Trauma Service, Harborview Medical Center, Seattle, WA.
Dean G
DG
Lorich
Peter D
PD
Fabricant
Gina
G
Sauro
Lionel E
LE
Lazaro
Ryan R
RR
Thacher
Matthew R
MR
Garner
Stephen J
SJ
Warner
D000368:Aged; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010329:Patella / Q000293:injuries* / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome