DOI: 10.1093/bjs/znad258.708 ISSN:

1310 Association of Anterior Knee Pain in Suprapatellar vs Infrapatellar Tibial Nailing Techniques. a Retrospective Cohort Study

M Waqas Ilyas, A Sh Amer, K Al-Kharouf, M Alaraj, H Vakil, S Zohaib, C Mitchell
  • Surgery



To assess whether there is a statistically significant difference between the incidence of anterior knee pain in supra-patellar vs infra-patellar tibial nailing techniques.


Data were collected from a single major trauma Centre in the UK and included all patients with tibial fractures who underwent fixation using IM nail. Out of 312 patients identified, 206 were included in the final data set who fulfilled the inclusion criteria. Patients were divided into two cohorts: “Suprapatellar Nailing” and “Infrapatellar Nailing”, and clinical follow-up records were looked at thoroughly to identify the incidence of anterior knee pain. Statistical analysis was performed to test the null hypothesis, i.e., “Documented anterior knee pain is higher in infrapatellar nailing vs suprapatellar nailing”.


Of 206 patients, 140 were males, and 66 were females, with a mean age of 43 years (Range 16-91). 60.2% (n = 124) were treated with infrapatellar nailing compared to suprapatellar nailing 39.8% (n = 82). Anterior knee pain was reported in 14.2% (n = 17) of the infrapatellar cohort compared to 14.6% (n = 12) in the suprapatellar cohort. The Chi-square statistic with yates’ correction is 0.0124, with a p-value of 0.91. The result is not significant (p > 0.05).


The mean incidence of anterior knee pain in both cohorts is 14.4 % on the literature's lower spectrum of reported results. We acknowledge that the sample size needed to attain statistical significance is enormous; our study results suggest no significant difference in the incidence of anterior knee pain in infrapatellar vs suprapatellar nailing techniques and can give uncertain outcomes in well-trained hands.

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