Review Question - QID 4403

The clinical presentation is consistent with and inferior pole patella fracture. Open reduction and internal fixation or excision with patellar tendon advancement is the most appropriate treatment of this injury pattern.

Whenever possible, salvage of the inferior pole through open reduction internal fixation is favored over simple excision and patellar tendon advancement, as this has been shown to be associated with improved outcomes. This is not always possible, however, and pole resection can be performed if the inferior comminution precludes fixation. Inferior outcomes of the partial distal patellectomy and patellar tendon advancement are (aside from the possible resulting patella baja) probably not directly related to the patellofemoral articulation. On the undersurface, the proximal 75% of the patella is covered with articular cartilage; however, the distal 25% is not, and does not articulate with the femoral trochlea.

Kastelec et al. performed a retrospective review of ORIF v. pole resection followed over 4.6 years postoperatively. There was a significant increase (better) in patellofemoral score with ORIF; significant differences in knee pain, tolerated activity levels, and ROM were also noted. Patella baja was frequently noted with pole resection and correlated with worse functional outcomes.

Matejcic et al. performed a retrospective review of ORIF v. pole resection followed over 5.3 years postoperatively. Results were excellent/good in 90.1% of the ORIF and only 73.1% of the pole resection patients. In addition, significant differences between the groups were noted with regard to knee pain, swelling, level activity, compression pain, range of motion, muscular atrophy, muscular strength, and final patellofemoral score (all better with ORIF).

Figure A is a lateral knee radiograph showing an inferior pole patella fracture.