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Anterior Knee Pain after tibial LL - solution?

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L
Libertin
Verified Member
Posts: 140
Joined: Aug 2014
Posted on Aug 4, 2014, 12:35 am
#1
Hello!

I found this article and am asking myself, if its conclusion has become known in this forum and if there are LL methods, which actually use this kind of approach?
Quote
The classic parapatellar and transtendon approaches are associated with postoperative knee pain. The etiology of this pain is likely multifactorial, including stretching the tendon intraoperatively, damage and scarring to the soft tissues, and infrapatellar nerve injury. This pain has a significant impact on patient outcome, particularly in young manual laborers, who are most commonly affected by tibial shaft fractures. The percutaneous lateral suprapatellar incision theoretically avoids these potential causes of pain, likely improving patient outcome and increasing patient satisfaction. It also allows the patient to avoid periods of limited activity due to the healing of a split tendon. This can be particularly important for athletes.
http://www.healio.com/orthopedics/knee/journals/ortho/%7B044d928d-d948-434f-a658-36cc26bcb2c1%7D/intramedullary-nailing-of-tibial-fractures-review-of-surgical-techniques-and-description-of-a-percutaneous-lateral-suprapatellar-approach
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M
Medium Drink Of Water
Verified Member
Posts: 235
Joined: Oct 2013
Posted on Aug 4, 2014, 12:48 am
#2
Interesting stuff.  Wish they'd known about this method in Beijing in 2007. :'(
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L
Libertin
Verified Member
Posts: 104
Joined: Aug 2014
Posted on Aug 4, 2014, 1:02 am
#3
I'm particularly interested in latest results of this technique. Does it really erase all knee pain issues?
Edit:
I'm not sure, but it seems that this method has been not tested enough or is subject to a limit unsolved yet.
Quote
The lateral suprapatellar access route for placement of an intramedullary nail in tibial fractures is an alternative that may be viable with adequate instruments, which need to be developed through more controlled studies.

 
http://www.scielo.br/scielo.php?pid=S0102-36162012000200005&script=sci_arttext&tlng=en

Please note that this study examined on cadavers only.
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S
Sweden
Verified Member
Posts: 348
Joined: Oct 2013
Posted on Aug 4, 2014, 1:25 am
#4
Nice to hear. Hopefully there will be a safe way to remove the rods in my legs in the future without having severe knee pain.

I'm not taking the risk of opening my knees again.
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M
Medium Drink Of Water
Verified Member
Posts: 465
Joined: Oct 2013
Posted on Aug 4, 2014, 2:00 am
#5
It should erase all the knee pain issues.  The place I have issues is where they split the patellar tendon open to insert the nail, which is on the front of the knee not the side.
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L
Libertin
Verified Member
Posts: 288
Joined: Aug 2014
Posted on Aug 4, 2014, 2:15 am
#6
Quote from: Sweden on August 04, 2014, 01:25:00 AM
Nice to hear. Hopefully there will be a safe way to remove the rods in my legs in the future without having severe knee pain.

I'm not taking the risk of opening my knees again.
I've red your blog in old forum . Apparently you are the only user there who reports long term knee pain?!

I have a shorter leg by 2cm and was originally advised to get Precice 2, but when I red of the problem with anterior knee pain, I was changing to external fixateur. These studies are new to me and I am currently asking my doctor, if he has heart of this approach already and whether it can be used with Precice 2.
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S
Sweden
Verified Member
Posts: 38
Joined: Oct 2013
Posted on Aug 4, 2014, 2:08 pm
#7
If I were to do only 2cm I'd go with external only.


I know I'm the only one.
Others are suffering in silence.
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T
TRS
Verified Member
Posts: 356
Joined: Feb 2014
Posted on Oct 30, 2014, 12:07 am
#8
Unfortunately there are not many studies on the suprapatellar nailing but even with the few available, they contradict one another. One of the studies http://www.ncbi.nlm.nih.gov/pubmed/24694557 shows the absence of anterior knee pain in all 36 supra patellar nailing patients. While http://upoj.org/wp-content/uploads/v24/09_Courtney.pdf shows no difference between suprapatellar and infrapatellar approach.
Theoretically, anterior knee pain associated with the standard infrapatellar nailing would not be an issue with the suprapatellar nailing because the surgeon would avoid the infrapatellar region which contains the saphenous nerve and the infrapatellar fat pad. Disturbance to the fat pad could cause fibrosis and potentially cause knee pain when kneeling down.
It would be great if we get professional opinion on this method.
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