The Spiderweb Technique for patellar fracture fixation using suture tape: a single-arm prospective case series

To evaluate the clinical and radiological outcomes of the Spiderweb Technique, a previously described all-suture tape fixation method for patellar fractures, with particular attention to its applicability in comminuted fracture patterns.

A single-arm prospective case series enrolled adults (≥ 21 years) with closed displaced patellar fractures treated using the Spiderweb Technique at a single centre (August 2022-December 2023). Fracture morphology was characterised by CT with 3D reconstruction and classified by 2018 AO/OTA criteria. The co-primary outcomes were radiographic union and functional outcome at 12 months with the use of Kujala score. Secondary outcomes were range of motion (ROM), visual analogue scale (VAS) pain score, complications and revision surgery.

Thirty-one patients (mean age 63.2 ± 12.9 years; 67.7% female) completed minimum 12-month follow-up. Fracture types comprised AO 34-C2 (48.4%), 34-C3 (41.9%), and 34-C1 (9.7%). Radiographic union was achieved in 96.8% by 3 months. One patient developed 4 mm displacement with delayed union in the context of reported rehabilitation protocol deviation, declined revision, and achieved union at 18 months with satisfactory function (Kujala 86, ROM 0-120°). Minor radiographic displacement < 2 mm was noted in five patients at 3 months, but none met the displacement criteria. Overall mean ROM improved from 95° ± 19 at 3 months to 111° ± 9 at 12 months. Median VAS was 0 at all timepoints. Mean 12-month Kujala score was 80.5 ± 15.6. No infections, thromboembolic events, symptomatic implants, or revision surgeries occurred. Mean operative time was 63.7 ± 15.5 min.

The Spiderweb Technique demonstrated feasibility with acceptable short-term outcomes in selected patellar fractures including comminuted patterns, with no patient undergoing revision surgery or implant removal. Comparative trial against tension band wiring with longer follow-up are warranted.