OBJECTIVES:
The purpose of this study was to compare the patient-reported functional outcomes after intramedullary nailing of the tibia through a retropatellar or infrapatellar approach. Radiographic assessment of nail entry point and accuracy of fracture reduction were included to aid in the identification of variables that may explain any difference in patient-reported outcomes.

DESIGN:
A retrospective radiographic and questionnaire-based assessment of patient-reported outcomes and complications after tibial nailing for trauma or limb reconstruction through a retropatellar or infrapatellar approach.

SETTING:
Regional limb reconstruction unit within a university teaching hospital.

PATIENTS/PARTICIPANTS:
Two consecutive series of 38 patients with intramedullary tibial nails inserted through a retropatellar approach, and 36 patients with a tibial nail inserted through an infrapatellar approach.

INTERVENTION:
Tibial nail insertion through either a retropatellar or infrapatellar approach.

MAIN OUTCOME MEASURES:
Patient-reported outcomes and complication rates and radiographic assessment of fracture reduction and nail insertion entry point.

RESULTS:
No significant difference was seen in Kujala score as a measure of anterior knee pain (P = 0.217), either in the physical (P = 0.372) or mental (0.504) components of the SF-12 between the groups, although there was a trend toward symptomatic intrusive knee pain in the infrapatellar group. A more accurate fracture reduction, both in terms of angulation (P = 0.003) and translation (P = 0.010) in the coronal plane, was seen in the retropatellar group. The entry point for nail insertion was more accurate in both the sagittal (P = 0.011) and coronal (P = 0.014) planes.

CONCLUSIONS:
Retropatellar tibial nail insertion is not associated with more anterior knee pain when compared with infrapatellar nail insertion but is associated with more accurate nail insertion and fracture reduction.

LEVEL OF EVIDENCE:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.