From the Research
The suprapatellar approach is generally considered better than the infrapatellar approach for tibial fractures due to its ability to provide easier nail insertion, better alignment, and reduced risk of anterior knee pain, as supported by the most recent and highest quality study 1.
Key Benefits of Suprapatellar Approach
- Reduced operative time and radiation exposure, as seen in a study comparing suprapatellar and infrapatellar approaches, where the suprapatellar approach resulted in significantly lower operative time (115 min vs 139 min) and radiation exposure (36 cGY/cm2 vs 76.33 cGY/cm2) 2
- Improved patient-reported outcomes, with a study showing superior Lysholm scores at a mean follow-up of 3 months (8-24 weeks) in the suprapatellar group 2
- Lower risk of malalignment complications, such as apex anterior angulation, due to better alignment of the proximal fragment 1
- Reduced risk of anterior knee pain, a common post-operative complaint with the infrapatellar approach, due to irritation of the patellar tendon and infrapatellar fat pad 1
Technical Advantages
- The semi-extended position during the suprapatellar approach makes fracture reduction easier, especially in comminuted or unstable fractures, and allows for better fluoroscopic imaging throughout the procedure 3
- The suprapatellar approach provides improved visualization of the starting point and entry angle, particularly beneficial in proximal tibial fractures where accurate nail placement is critical 1
Clinical Outcomes
- A systematic review and meta-analysis of 15 studies involving 1396 patients found that the suprapatellar approach significantly reduced fluoroscopy time, operative time, pain scores, and improved Lysholm scores and malalignment rate compared to the infrapatellar approach 1
- Another study found that the suprapatellar approach resulted in lower VAS pain scores and higher Lysholm knee scores at 6 and 24 months post-operatively compared to the infrapatellar approach 4