A novel approach to the minimally invasive application of a tension band for transverse patellar fractures assisted by a nice knot.

Abstract

Background: The tension band internal fixation is a well-established surgical technique employed for the managing of transverse patellar fractures. Nevertheless, there is a lack of comprehensive documentation on minimally invasive tension band fixation in academic literature. In this study, we investigated the utilization of Nice knot assistance during the procedure and assessed its impact on clinical outcomes in comparison to traditional open surgery.

Methods: Fourty-two patients with transverse patellar fractures participated in this study, twenty of whom underwent minimally invasive surgery and twenty-two underwent open surgery. In the minimally invasive group, intraoperative tension band internal fixation was performed using Nice knot assisted reduction. Postoperative knee pain, knee mobility, operative time, complications, number of intraoperative C-arm fluoroscopy scans, length of hospital stay (in days), and Bostman score were recorded for each patient in both groups.

Results: The minimally invasive group had significantly longer operating times compared to the open surgery group (65.9 ± 9.3 min VS 60.8 ± 7.3 min, P = 0.054). Fluoroscopy during surgery was notably more frequent in the minimally invasive group compared to the open surgery group (4.1 ± 0.8 vs. 2.5 ± 0.6, P < 0.001). The patients had significantly higher VAS scores in the open surgery group compared to the minimally invasive group at multiple postoperative time points. The difference was not significant at 3 months (P = 0.025 ). Furthermore, the minimally invasive group exhibited a higher mean knee flexion angle and the Bostman score compared to the open surgical group.There were complications in 4 patients (18.2%) in the open surgery group and 2 patients (10.0%) in the minimally invasive surgery group, with no significant difference between the two groups (p = 0.752).

Conclusions: It has been demonstrated that using the Nice knot in the minimally invasive treatment of transverse patellar fractures improves the reduction effect and decreases the incidence of iatrogenic fractures.Patients who underwent minimally invasive surgery experienced early postoperativepain reduction, improved knee range of motion, improved Bostman scores, early postoperative, discharge and incidence of complications.