Biomechanical comparison of a novel tensioned cable construct versus tension band wiring for transverse patella fracture fixation

Tension band wiring (TBW) is the most widely accepted method for patella fracture fixation. The purpose of our study was to compare the biomechanical efficacy of a novel cable construct to TBW for the fixation of transverse patella fractures. The tensioned cable construct was hypothesized to have less fracture gapping after cyclic flexion-extension loading and greater ultimate load to failure as compared to TBW.

Transverse patellar osteotomies (AO/OTA 34C1.1) were performed on nine pairs of fresh-frozen human cadaveric whole legs (mean age 82.2 years, range 71-101). Treatment with TBW or tensioned cable construct was randomized within each specimen pair. Fracture site displacement was measured after 5000 flexion-extension cycles from 0° to 90° at 0.5 Hz. In load to failure testing, the knee was fixed at 45° of flexion and the quadriceps tendon was pulled proximally at 0.5 mm/sec until patella fixation failure. Comparisons were made using paired t-tests with alpha values of 0.05.

Eight paired specimens completed the cyclic loading. The tensioned cable construct had significantly less fracture gapping than TBW (2.9 vs 10.9 mm; p = 0.020). Seven paired limbs underwent load to failure testing, which revealed no significant difference between the tensioned cable construct and TBW (1551.6 N vs 1664.0 N; p = 0.26).

In this study of transverse patella fracture fixation, a tensioned cable construct demonstrated significantly less fracture gapping compared to TBW in response to cyclic loading with no significant difference in load at failure.