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.+/- 2 6 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 95.7 +/- 6 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.