Tension band wiring versus suture anchoring for inferior pole patellar fractures: a systematic review and meta-analysis

Inferior pole patellar fractures present surgical challenges due to their comminuted nature. Tension band wiring (TBW) is a commonly used fixation technique. However, it is associated with complications such as hardware prominence and soft tissue irritation. Suture anchor (SA) fixation has been proposed as an alternative to TBW that aims to reduce hardware-related complications. This study aimed to compare the clinical outcomes of TBW and SA fixation for inferior pole patellar fractures. A literature search was conducted in the PubMed, Embase, Cochrane Library, and Scopus databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies comparing TBW and SA fixation for inferior pole patellar fractures. Outcome data were collected, including operative time, intraoperative blood loss, functional scores (Bostman score, Insall–Salvati ratio, and range of motion), fracture union time, and postoperative complications. Heterogeneity was assessed using the I2 statistic. Pooled analyses were performed using risk ratios and mean differences with 95% confidence intervals. A total of 5 retrospective cohort studies involving 227 patients treated with TBW (n = 121) and SA fixation (n = 106) were included in the analysis. The SA group demonstrated higher Bostman scores and a greater range of motion than the TBW group (p < 0.05). No significant differences in operative time, intraoperative blood loss, Insall–Salvati ratio, or fracture union time were observed between the two groups (p > 0.05). SA fixation was associated with a lower postoperative complication rate than TBW (2 vs. 23, p < 0.05). TBW and SA fixation for inferior pole patellar fractures were associated with comparable clinical and radiological outcomes. SA fixation demonstrated modest improvements in functional scores and lower complication rates. However, the clinical relevance of these differences remains uncertain, and caution should be exercised when interpreting the results. Further high-quality prospective studies are needed to better evaluate the effectiveness of these techniques.