Interventions for Treating Fractures of the Patella in Adults

Summary

A Cochrane review [Abstract] 1 included 11 studies with a total of 564 adult subjects with patella fracture. All 11 trials compared different surgical interventions for patella fractures. The trials tested one of seven comparisons.

Four trials (174 participants) compared percutaneous osteosynthesis versus open surgery. There is uncertain difference between the two interventions in patient-rated knee function at 12 months (1 study, 50 participants) or in knee pain at intermediate-term follow-up at eight weeks to three months. It is uncertain whether, compared with open surgery, percutaneous fixation surgery reduces the incidence of major adverse outcomes, such as loss of reduction and hardware complications, or results in better observer-rated knee function scores.

Two trials (112 participants) compared cable pin system (open or percutaneous surgery) versus tension band technique. There are uncertain findings at one year in favour of the cable pin system of slightly better patient-rated knee function, fewer adverse events and slightly better observer-rated measures of knee function. There was uncertain evidence of little clinically important between-group difference in knee pain at three months.

There is uncertain evidence from two small trials (47 participants) of little difference between biodegradable versus metallic implants at two-year follow-up in the numbers of participants with occasional knee pain, incurring adverse events or with reduced knee motion. There is incomplete evidence from single trials for four other comparisons: one trial (28 participants) that compared patellectomy with advancement of vastus medialis obliquus surgery with simple patellectomy; of one quasi-RCT (56 participants) that compared a new intraoperative reduction technique compared with a standard technique; of one quasi-RCT (65 participants) that compared a modified tension band technique versus the conventional AO tension band wiring (TBW) technique; and of one trial (57 participants) that compared adjustable patella claws and absorbable suture versus Kirschner wire tension band.