Knee Pain and Functional Scores After Intramedullary Nailing of Tibial Shaft Fractures Using a Suprapatellar Approach.

OBJECTIVES

To evaluate the effects of intramedullar nailing of the tibia using a suprapatellar (SP) approach with respect to pain and function of the knee.

DESIGN

Prospective clinical investigation.

SETTING

Academic level I trauma center.

PATIENTS/PARTICIPANTS: Twenty-one patients with tibial shaft fractures (Orthopaedic Trauma Association 42A-B-C) with a minimum of 12-month follow-up.

INTERVENTION

Locked intramedullary nailing using a SP approach.

MAIN OUTCOME MEASUREMENTS

Radiographic evaluation for nail position proximally, tibial shaft alignment and union, anterior knee pain using the visual analog scale, and knee function evaluation using the Lysholm and SF-36 scores. Examination of intra-articular damage was performed using intraoperative patellofemoral arthroscopy before and after nail insertion.

RESULTS

The mean age of the patients was 35.4 ± 12.4 years (range, 18-63 years), and the mean follow-up period was 15.62 ± 3.2 months (range, 12-21 months). The visual analog scale score for anterior knee pain was a mean of 1.0 ± 1.3 (range, 0-4). The SF-36 physical score was mean 45.1 ± 9, and the SF-36 mental score was a mean of 51.7 ± 9.9. The knee joint range of movement was measured as 133.1 ± 87 degrees on the affected extremity side and 134.05 ± 8.4 degrees on the unaffected side. The mean Lysholm knee score was 95.76 ± 4. No intra-articular pathology was seen on arthroscopy after nail insertion.

CONCLUSIONS

The SP approach for intramedullar nailing for tibial shaft fractures was not associated with either anterior knee pain or functional limitations of the knee in our series.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.