1 Principles top
The patello-femoral joint is biomechanically very stressed when the knee is loaded. Any compromise of the joint surface is likely to lead to degenerative joint disease. It is, therefore, highly desirable, in patellar fractures to strive for anatomical reduction of the joint surface and stable fixation.
An additional treatment goal is restoration of function of the knee extensor mechanism and allow early range of motion of the knee.
2 Patient preparation and approach topenlarge
This procedure is normally performed with the patient in a supine position with the knee flexed 30°.
For this procedure a mid-axial longitudinal approach is used.
3 Reduction and fixation topenlarge
The knee joint and fracture lines must be irrigated and cleared of blood clot and small debris to allow exact reconstruction.
The larger fragments are reduced using a pointed reduction forceps or tenaculum.
Sagittal fractures are more easily reduced with the knee flexed.
Reduction is held by one or two reduction forceps.
Verify the reduction by palpation of the retropatellar surface.
Two K-wires are inserted through the planned screw trajectory with the fracture reduced
Drill holes are made over the K-wires.
The suture anchor is inserted with a stitch coming out the hole.
When these anchors are used in pairs, the stitch is tied to its partner to ensure good fixation.