The relationship between anterior knee pain occurring after tibial intramedullary nailing and the localization of the nail in the proximal tibia

Abstract

We investigated the relationship between the development of postoperative anterior knee pain and the location of the nail in the proximal tibia in patients treated with locked intramedullary nailing for tibial diaphyseal fractures. Thirty patients were selected among those who underwent locked intramedullary nailing for tibial diaphyseal fractures, with exclusion of all other factors that might be associated with postoperative anterior knee pain. In all the patients, intramedullary nailing was performed using the transtendinous approach and both proximal and distal locking. The patients were evaluated in two groups: 10 patients (3 women, 7 men; mean age 38 + or - 14 years) had anterior knee pain, whereas 20 patients (5 women, 15 men; mean age 35 + or - 12 years) did not. The distances from the nail to the tibial plateau and anterior tibial cortex were measured on the lateral x-rays after a mean follow-up of 56.6 months and 45.2 months in patients with and without anterior knee pain, respectively. The two groups were similar with respect to gender and follow-up period (p>0.05). The mean distances from the nail to the tibial plateau and anterior tibial cortex were -11.5 + or - 7.9 mm and 3.7 + or - 5.4 mm, respectively, in patients with anterior knee pain. The corresponding distances were -8.8 + or - 7.3 mm and 6.5 + or - 4.7 mm in patients without knee pain. Neither of the distances showed a significant difference between the two groups (p>0.05). Our findings suggest that the distances from the nail to the tibial plateau and anterior tibial cortex do not have any role in the development of postoperative anterior knee pain.