A systematic review and meta-analysis looked at two ways to make an incision during surgery for tibial shaft fractures. The study combined data from 1,264 adults who underwent intramedullary nailing. Researchers compared the medial parapatellar approach with the transpatellar approach to see how they affected recovery.
The analysis found that the medial parapatellar approach was associated with a lower risk of anterior knee pain at the latest follow-up in cohort studies. In randomized trials, trends toward less pain were seen but did not reach statistical significance. Pain scores were also generally lower with the medial approach at three months.
Functional outcomes and range of motion generally favored the medial approach, though results were inconsistent and could not be pooled. Fracture healing and union rates were comparable between the two methods. No serious adverse events were reported in the safety data.
The study authors note that high-quality studies with standardized measures are essential to validate these findings. Because the evidence comes from a mix of retrospective and randomized studies, readers should view these results as associations rather than proven causes.