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J Knee Surg 2021; 34(01): 080-086
DOI: 10.1055/s-0039-1692673
Original Article

Functional Outcomes of Revision Osteosynthesis after Failure of Surgical Treatment of Patellar Fractures

Elena Caroline Müller
1   Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
,
Karl-Heinz Frosch
1   Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
2   Department of Trauma and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf UKE, Hamburg, Germany
› Author Affiliations Funding The study was funded by Asklepios Kliniken Hamburg GmbH.
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Abstract

Patellar fractures account for approximately 1% of all skeletal fractures. These fractures are rare; however, because of the crucial function of the patella in the extensor mechanism of the knee, they may lead to serious impairment. New data are revealing functional impairment remains common even with improved surgical techniques. The aim of this study was to assess the functional outcomes of patients after revision surgery in cases of secondary fracture dislocation or persistent articular incongruity. This study included 16 patients with a mean age of 51.8 years (range: 16–85 years) with a mean follow-up of 35.1 months. According to the AO/OTA classification, 15 patients had a C-type fracture, including 10 patients with C3 fracture. Thirteen patients were initially treated with tension band wiring via K-wires or cannulated screws. Revision surgery was performed because of persistent articular incongruity in five patients and secondary fracture dislocation or refracture in 11 patients. We analyzed pain (visual analog scale [0–10]), satisfaction, range of motion (ROM), Böstman's score, Lysholm's score, and knee injury and osteoarthritis outcome score (KOOS) after revision surgery and could extract follow-up data from 15 patients. Mean pain score at rest was 0.57 (range: 0–3.5) and on exertion 2.79 (range: 0–8). The measurement of the ROM of the affected knee compared with that of the opposite knee revealed complete extension. Mean flexion was 123 degrees, in the corresponding knee it was 136 degrees (p = 0.05). The mean postoperative Böstman's and Lysholm's scores were 25.11 (good, maximum: 30) and 78.67 (moderate, maximum: 100), respectively. KOOS was as follows: symptoms, 66.8 points; pain, 77.55 points; activity of daily living (ADL), 75.67 points; and quality of life, 56.25 points. The results of this study suggested that early revision surgery after failure of primary osteosynthesis with secondary anatomic reconstruction and good radiological results leads to satisfactory functional outcomes with persistent functional deficits.

Keywords

patellar fracture - revision surgery - functional outcome


Publication History

Received: 26 September 2018

Accepted: 19 May 2019

Article published online:
09 July 2019

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