Suture anchor fixation as a viable alternative to tension band wiring for inferior pole patellar fractures: a retrospective comparative study.

Abstract

Inferior pole patellar fractures are difficult to treat because fixation must restore extensor continuity while minimizing hardware-related complications. This study compared the clinical outcomes of tension band wiring (TBW) and suture anchor fixation (SAF). We retrospectively reviewed 45 adult patients with inferior pole patellar fractures treated between September 2020 and September 2023. Twenty-nine patients underwent TBW and 16 underwent SAF. The primary outcomes were fracture union time, postoperative complications, maximum knee flexion at 12 months, and Bostman patellar score. Fracture union time did not differ significantly between the TBW and SAF groups (8.60 ± 1.10 vs. 8.00 ± 1.63 weeks, P = 0.202). Bostman scores were also comparable (P = 0.531). However, SAF resulted in significantly greater knee flexion at 12 months than TBW (119.2° ± 3.87° vs. 114.9° ± 4.24°, P = 0.002). Postoperative complications occurred in 12 of 29 patients (41.4%) in the TBW group, including one case of Kirschner wire migration with superficial infection requiring debridement, eight cases of implant irritation requiring hardware removal after union, and three cases of anterior knee pain treated conservatively. No hardware-related complications or secondary surgeries occurred in the SAF group (0/16, P = 0.003). SAF is a viable alternative to TBW for inferior pole patellar fractures. In this cohort, SAF provided comparable fracture healing and functional scores, while reducing implant-related morbidity and improving postoperative knee flexion. Larger prospective multicenter studies with longer follow-up are needed to confirm these findings.