Transosseous sutures versus vertical cerclage wire for distal pole patellar fractures: a retrospective comparative cohort study.

PURPOSE: To compare transosseous sutures (TOS) and vertical wire cerclage (VCW) for treating distal pole patellar fractures, evaluating clinical outcomes, patient-reported outcome measures (PROMs), radiographic outcomes, and complications.

METHODS

We conducted a retrospective comparative cohort study of patients surgically treated for patellar distal pole fractures (AO/OTA 34A1b) with either TOS or VCW between 2015 and 2023. Patient characteristics, surgical technique, postoperative data, patellar height, and complications were recorded. Functional outcomes were evaluated at a minimum of 12 months postoperatively using PROMs (Kujala, Lysholm, and Bostman scores). The primary outcome of this study was functional recovery, assessed via the Bostman score at 12 months.

RESULTS

A total of 46 patellar distal pole fractures were included (30 TOS and 16 VCW). Baseline characteristics showed no statistically significant differences between groups. No significant differences were found regarding clinical or functional outcomes. Regarding radiographic outcomes, patellar height remained stable; however, both groups showed significant patellar length variation, with elongation being significantly more pronounced in the TOS group (mean 3.77 mm) compared to the VCW group (mean 0.44 mm; p = 0.001). While overall complication rates showed no statistically significant difference, all five cases of nonunion occurred exclusively in the TOS group.

CONCLUSION

Both transosseous sutures and vertical cerclage wire techniques demonstrate favorable clinical and functional outcomes in this cohort. However, the TOS technique was associated with a greater increase in patellar length and a higher clinical frequency of nonunion. These findings warrant further investigation to elucidate their etiology and long-term clinical relevance.