• Mandala S Leliveld, VerhofstadMichael H JMHJTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands., Eduard Van Bodegraven, Jules Van Haaren, and Van LieshoutEsther M MEMMhttp://orcid.org/0000-0002-2597-7948Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. e.vanlieshout@erasmusmc.nl..
• Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
• Eur J Trauma Emerg Surg. 2021 Jun 1; 47 (3): 763-772.

PurposeThe aim of this systematic review was to compare knee pain and function after tibial nail insertion through an infrapatellar, semi-extended and suprapatellar technique.MethodsA search was carried out to identify articles with an exact description of the method used for insertion of the tibial nail and description of the outcome parameters (knee pain or function). Data on study design, population, rate and severity of anterior knee pain and function scores were extracted. Pooled rates and scores were calculated.Results67 studies with 3,499 patients were included. The pooled rate of patients with anterior knee pain was 38% (95% CI 32-44) after nail insertion through an infrapatellar approach and 10% (95% CI 1-26) after insertion through a suprapatellar approach. Pooled analysis was not possible for the semi-extended technique. Knee pain scores as measured by visual analogue score (0-10) ranged from 0.2 (95% CI - 0.1-0.5) for general knee pain to 3.7 (95% CI 1.3-6.1) for pain during kneeling. Pooled estimates for the Lysholm score were 87 points (range 77-97) for the infrapatellar technique and 85 points (range 82-85) for the suprapatellar technique. Iowa Knee scores were 94 (range 86-96) and Anterior Knee Pain Scale scores were 76 (range 75-80) after infrapatellar nail insertion.DiscussionDepending on the technique used, the proportion of patients with knee pain after tibial nailing varied between 10 and 38%. The actual measured knee pain scores were, however, surprisingly low. Knee function was good for both the infra- and suprapatellar technique.

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