Dean G Lorich1, Peter D Fabricant, Gina Sauro, Lionel E Lazaro, Ryan R Thacher, Matthew R Garner, Stephen J Warner. 1. *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.
Abstract
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. DESIGN: Comparative cohort study. SETTING: Academic level I trauma center. PATIENTS/PARTICIPANTS: 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. INTERVENTION: Surgical fixation of patella fractures was performed with either a tension band or novel plate construct. MAIN OUTCOME MEASUREMENTS: 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. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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. DESIGN: Comparative cohort study. SETTING: Academic level I trauma center. PATIENTS/PARTICIPANTS: 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. INTERVENTION: Surgical fixation of patella fractures was performed with either a tension band or novel plate construct. MAIN OUTCOME MEASUREMENTS: 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. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Authors: Jake X Checketts; Jared Scott; Keith Fishbeck; Thomas Hart; William Pham; Azad Dadgar; Mark Calder; Brent L Norris Journal: JB JS Open Access Date: 2022-05-12