The relationship between the quadriceps muscle strength and the anterior knee pain occurring after locked intramedullary nailing for tibial diaphysis fractures

Objectives: The relationship between the quadriceps muscle strength and anterior knee pain occuring after locked tibial intramedullary nailing for tibial shaft (diaphysis) fracture was investigated. Patients and methods: Thirty-eight patients who were treated with locked intramedullary nailing for tibial shaft fractures were included in this study. The patients who had anterior knee pain before the surgery were excluded. All patients were operated on by splitting the patellar tendon in the middle and using superior approach. The fractures were all statically locked. Isometric quadriceps strengthening exercises were begun immediately in the postoperative period. The patients were divided into two groups whether they had anterior knee pain (group I; 01) or not (group 2; G2). There were 18 patients in G1 (12 males, 6 females; mean age 36.9 years) and 20 patients (14 males, 6 females; mean age 35.4 years) in G2. Quadriceps muscle strength was evaluated with using the Daniel ve Worthingham's manual grading criteria (0-5). The mean follow-up time was 27.4 months (range 11-51 months) in G1 and 30.5 months (range 12-59 months) in G2. Results: Decrease in quadriceps muscle strength was observed in eight patients in G1 and two patients in G2. The relation between anterior knee pain and decrease in quadriceps muscle strength was significant (p=0.02). Conclusion: Anterior knee pain after intramedullary nailing of tibial shaft fractures is related to quadriceps muscle weakness. However quadriceps muscle weakness is not the only effective factor that leads to anterior knee pain. Anterior knee pain can be reduced mostly with appropriate rehabilitation programme.