J Korean Fract Soc.  2022 Oct;35(4):129-134. 10.12671/jkfs.2022.35.4.129.

Intra-Articular Alterations after Suprapatellar Nailing in Tibial Shaft Fractures: An Arthroscopic Evaluation

• Lee G
• Yang SH
• Jo SM
• Kook JM

• KMID: 2534401
• DOI: http://doi.org/10.12671/jkfs.2022.35.4.129

Abstract

Purpose
This study attempted to study the intra-articular changes due to intramedullary nailing through the suprapatellar approach by evaluating the joint cartilage damage and presence of foreign bodies through a comparison of the pre- and post-operative status evaluated by knee arthroscopy.
Materials and Methods
This retrospective study analyzed fifteen patients who underwent intramedullary nailing through the suprapatellar approach for proximal tibial shaft fracture from January 2017 to March 2020. The condition of the joint cartilage and the presence of foreign substances in the patellofemoral joint were evaluated. The cartilage status of the patellofemoral joint was evaluated using the International Cartilage Repair Society (ICRS) grading system. Data from the ICRS grading and the visual analogue scale (VAS) scores of the femoral and patellar cartilage were compared to each independent variable surveyed.
Results
All the intra-articular structures before nailing were normal. In all cases after nailing, articular cartilage damage of the patellofemoral joint and intra-articular debris were observed. The average VAS score was 0.6 (0-1) before surgery and 2.27 (0-4) after surgery. There were no statistically significant differences except for the correlation in the diameter of the tibia nail and femoral ICRS grade (p=0.001) and the damage to the cartilage was greater in the femoral cartilage than that to the patella (p=0.001).
Conclusion
Intra-articular damage appears to be unavoidable in suprapatellar nailing. Further research is needed on the long-term effects of intra-articular damage and on methods to reduce this damage.

Keyword

Tibial fracture; Proximal; Patellofemoral joint; Suprapatellar; Intramedullary nailing