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Objectives <p>Altered patellar height following patella fracture repair may affect clinical outcomes, but the significance remains unclear. The purpose of this study was to evaluate the impact of immediate and final follow-up Insall-Salvati Ratio (ISR) on postoperative outcomes following patella fracture fixation.</p> Methods <p>A retrospective review at a multi-site academic urban hospital system was conducted. All patients underwent patella open reduction and internal fixation (ORIF) for displaced patella fracture (OTA 34) from 2012 to 2024. Final intraoperative and final follow-up radiographs were assessed by Insall-Salvati ratios (ISR). Patients were categorized into groups based on intraoperative ISR measurements: normal ISR, defined as .8–1.2 and abnormal ISR, outside of the 0.8–1.2 range. Follow-up radiographs were also assessed for abnormal ISR. Knee range of motion (ROM), post-operative complications, and fracture union were collected. Statistical analysis included Pearson Chi-squared tests, independent t-tests, and ANOVA tests.</p> Results <p>Of 191 patients, 163 (85.3%) had normal ISR and 28 (14.7%) had abnormal ISR postoperatively. Abnormal ISR was associated with higher complication rates (14.3% vs. 4.3%, <i>p</i> = 0.037), hardware failure (10.7% vs. 1.2%, <i>p</i> = 0.004), reduced knee range-of-motion at three months (105.13 ± 21.38 vs. 117.22 ± 13.75, <i>p</i> &lt; .001) and six months (119.25 ± 14.26 vs. 127.37 ± 13.27, <i>p</i> = .020). Among patients with initially normal ISR, 12.3% developed patella baja, which was associated with higher rates of hardware removal (20% vs. 3.1%, <i>p</i> = 0.004) and infection (10% vs. 0.8%, <i>p</i> = 0.015) when compared to patients maintaining a normal ISR.</p> Conclusions <p>Abnormal intraoperative Insall-Salvati ratio following patella fracture repair was associated with poorer knee ROM and increased complication rate. Progressive development of patella baja during fracture healing was associated with hardware removal and fracture related infection. Attention to intraoperative ISR optimization may improve outcomes.</p>

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Alteration of Insall-Salvati ratio is associated with complications following fixation of patella fractures

  • 期刊论文

  • 发表日期：

    2025年12月23日

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  • Alexander Lashgari,
  • Benjamin Hammond,
  • Benjamin Padon,
  • Abhishek Ganta,
  • Sanjit Konda,
  • Kenneth Egol

摘要

Objectives

Altered patellar height following patella fracture repair may affect clinical outcomes, but the significance remains unclear. The purpose of this study was to evaluate the impact of immediate and final follow-up Insall-Salvati Ratio (ISR) on postoperative outcomes following patella fracture fixation.

Methods

A retrospective review at a multi-site academic urban hospital system was conducted. All patients underwent patella open reduction and internal fixation (ORIF) for displaced patella fracture (OTA 34) from 2012 to 2024. Final intraoperative and final follow-up radiographs were assessed by Insall-Salvati ratios (ISR). Patients were categorized into groups based on intraoperative ISR measurements: normal ISR, defined as .8–1.2 and abnormal ISR, outside of the 0.8–1.2 range. Follow-up radiographs were also assessed for abnormal ISR. Knee range of motion (ROM), post-operative complications, and fracture union were collected. Statistical analysis included Pearson Chi-squared tests, independent t-tests, and ANOVA tests.

Results

Of 191 patients, 163 (85.3%) had normal ISR and 28 (14.7%) had abnormal ISR postoperatively. Abnormal ISR was associated with higher complication rates (14.3% vs. 4.3%, p = 0.037), hardware failure (10.7% vs. 1.2%, p = 0.004), reduced knee range-of-motion at three months (105.13 ± 21.38 vs. 117.22 ± 13.75, p < .001) and six months (119.25 ± 14.26 vs. 127.37 ± 13.27, p = .020). Among patients with initially normal ISR, 12.3% developed patella baja, which was associated with higher rates of hardware removal (20% vs. 3.1%, p = 0.004) and infection (10% vs. 0.8%, p = 0.015) when compared to patients maintaining a normal ISR.

Conclusions

Abnormal intraoperative Insall-Salvati ratio following patella fracture repair was associated with poorer knee ROM and increased complication rate. Progressive development of patella baja during fracture healing was associated with hardware removal and fracture related infection. Attention to intraoperative ISR optimization may improve outcomes.