Comparison of Medial Parapatellar Tendon Approach vs Trans-Patellar Tendon Approach of Imil Nail for Diaphyseal Tibial Fractures

Abstract

Background: Anterior knee pain is a frequent issue that arises after the fixation of tibial fractures using an intramedullary interlocking nail (IMIL). Although the transpatellar tendon approach is most commonly used, the medial parapatellar tendon approach has been suggested as an alternative that may reduce postoperative discomfort. Objective: The goal of this research was to assess postoperative anterior knee pain resulting from IMIL nailing conducted through the medial parapatellar tendon method compared to the transpatellar tendon method. Study Design: Cross-sectional study. Settings: DHQ Teaching Hospital, Sahiwal, Pakistan. Duration: June to September 2025. Methods: This controlled trial was randomized and carried out in the Department of Orthopedic Surgery at DHQ Teaching Hospital, Sahiwal, over a period of four months. A total of 60 patients with diaphyseal tibial fractures fulfilling the inclusion criteria were enrolled and randomly allocated into two groups, with 30 patients in each group. Group A patients underwent IMIL nailing through the medial parapatellar tendon approach, while Group B patients underwent IMIL nailing through the transpatellar tendon approach. Patients were evaluated postoperatively for anterior knee pain using the Visual Analogue Scale (VAS) at 2, 6, and 12 weeks. Results: of the 60 patients, 48 were male and 12 were female. Right tibia involvement was slightly more frequent than left-sided fractures. Road traffic accidents were the leading cause of injury, followed by falls. At 12 weeks follow-up, the mean VAS score for anterior knee pain in Group A was 2.6±0.58, whereas in Group B it was 4.3±0.61. The difference was statistically significant (p < 0.001). Conclusion: This study demonstrates that the medial parapatellar tendon approach for IMIL nailing results in significantly less postoperative anterior knee pain compared to the transpatellar tendon approach, provided that other causes, such as a prominent nail or intra-articular injury, are avoided.