Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia.

©2006 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.88B5. 16875 $2.00 J Bone Joint Surg [Br] 2006;88-B:576-80. Intramedullary nailing is considered to be the optimum treatment for fractures of the long bones of the lower limbs and various studies have been published describing the functional outcome of both reamed and unreamed nailing. 1-15 Several complications have been described including infection, 2,13,14 compartment syndrome, 16-29 deep-vein thrombosis, 30-32 thermal necrosis of the bone with alteration of its endosteal architecture, 33-40 failure of the metalwork 16,20,22,23,27 and malunion and nonunion of the fracture. 2,3,6,15,41-44 However, one of the most common problems associated with tibial primarily, and retrograde femoral nailing secondarily, is chronic anterior knee pain. 15,43,45-51 This can be an important handicap for the patient, affecting his employment and daily or leisure activities. Its incidence has been reported to be as high as 86%. 52 It may be present even in patients who have an intact knee as with antegrade femoral nailing. 7,15,30,43,44,51,53,54 Its aetiology is unclear, but a multifactorial origin has been suggested. We have carried out a comprehensive review of the literature in order to determine the incidence of this complication, understand its pathophysiology and establish some recommendations and guidelines which may reduce its prevalence.