Patellar distal pole fracture treatment with transosseous sutures vs vertical cerclage wire techniques: a comparative retrospective cohort study

Purpose To compare transosseous sutures (TOS) and vertical wire cerclage (VCW) for treating distal pole patellar fractures and evaluate their equivalence in terms of clinical outcomes, patient reported outcome measures (PROMs), radiographic outcomes and complications. Methods We conducted a non-concurrent cohort study retrospectively reviewing all patients surgically treated for patellar distal pole fractures (AO/OTA 34A1b) with either TOS or VCW between 2015 and 2023. Patient characteristics, surgical technique and postoperative follow-up data, patellar height and complications were recorded. Functional outcomes were evaluated at least 12 months postoperatively using PROMs (Kujala, Lysholm and Bostman scores). Internal approval of the Institutional Ethics Committee was gained, and informed consent was obtained from all patients. Results A total of 46 patellar distal pole fractures were included; 30 TOS and 16 VCW. Baseline characteristics were comparable between groups. No significant differences were found between groups regarding clinical nor functional outcomes or complications. No significant differences were found respecting patellar height. However, significant length variation was found in the TOS group, with a mean elongation of 3.77 mm (p 0.001). Conclusion Both Transosseous sutures and vertical cerclage wires reinsertion techniques achieve good clinical and radiographic outcomes. Nonetheless, the finding of patellar elongation warrants further investigation to elucidate its etiology and potential clinical relevance.