Skip to main content
JDRS · Open access journal
Joint Diseases and
Related Surgery
Online manuscript submissionSubmit a manuscript e-ISSN 2687-4792

Original Article · Open access

Cannulated screw tension band versus Kirschner wire tension band for patellar fractures: A systematic review and meta-analysis

PDF Cite this article

Zhong-bo Deng

Department of Orthopedics, Tianjin University Tianjin Hospital, Tianjin, China

ORCID: 0009-0009-8431-9425

Duo Shan

Department of Orthopedics, Tianjin University Tianjin Hospital, Tianjin, China

ORCID: 0009-0001-8801-3951

Feng Pan

Department of Orthopedics, Jinnan Hospital, Tianjin, China

ORCID: 0009-0002-8435-5513

Yang-jing Cao

Department of Orthopedics, Jinnan Hospital, Tianjin, China

ORCID: 0009-0009-3319-0924

Abstract

Objectives: This meta-analysis aimed to systematically compare the clinical outcomes of cannulated screw tension band (CSTB) and Kirschner wire tension band (KWTB) fixation for patellar fractures.

Materials and methods: Comprehensive searches were conducted in the Cochrane Library, Web of Science, PubMed, Embase, and SpringerLink databases for studies published through July 2025. Search terms included “cannulated screw,” “Kirschner wire," “tension band,” and “patellar fracture.” Mean differences (MDs) and odds ratios (ORs) were utilized as pooled effect measures, with 95% confidence intervals (CIs).

Results: Eleven studies involving 1,358 patients with patellar fractures met the inclusion criteria. Meta-analysis revealed no statistically significant differences between the groups in terms of operative time (MD = 4.00; 95% CI –1.82 ~ 9.82; p = 0.18), fracture healing time (MD = 0.08; 95% CI –0.07 ~ 0.22; p = 0.28), or postoperative Visual Analog Scale scores (MD = 0.21; 95% CI –0.74 ~ 1.15; p = 0.67). However, CSTB fixation demonstrated significantly superior postoperative knee range of motion (ROM) (MD = –7.16; 95% CI –9.34 ~ –4.98; p < 0.00001), higher Lysholm scores (MD = –4.80; 95% CI –6.62 ~ –2.99; p < 0.00001), and significantly lower rates of reoperation (OR = 5.14; 95% CI 2.66 ~ 9.93; p < 0.00001) and overall complications (OR = 14.19; 95% CI 4.85 ~ 41.56; p < 0.00001) compared to KWTB.

Conclusion: For patellar fracture fixation, CSTB offers significant advantages over KWTB in terms of postoperative knee ROM, functional outcomes, reoperation rates, and overall complication rates.

* These authors contributed equally to this work.

Declarations

Author Contributions

Z.B.D., D.S., F.P., Y.J.C.: Contributed to conception and design of this study, study selection and data extraction of the finally included studies were done independently assessed the methodological quality of each included study, contributed to preparation of the manuscript. The final version of the article was approved by all the authors.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

References

  1. Bahadır B, Sezgin EA, Atik OŞ. Established practices and future insights into patellar instability surgery: A review. Jt Dis Relat Surg 2024;35:594-5. DOI: 10.52312/jdrs.2024.57924.
  2. Larsen P, Court-Brown CM, Vedel JO, Vistrup S, Elsoe R. Incidence and epidemiology of patellar fractures. Orthopedics 2016;39:e1154-8. DOI: 10.3928/01477447-20160811-01.
  3. Vedel JO, Vistrup S, Larsen P, Elsoe R. Altered long-term health-related quality of life in patients following patella fractures: A long-term follow-up study of 49 patients. Eur J Trauma Emerg Surg 2018;44:707-16. DOI: 10.1007/s00068-017-0857-8.
  4. Yan X, Wang K, Jia X, Rui Y, Zhou M. Krackow suturing combined with the suture-bridge technique versus Kirschner-wire tension band combined with patellar cerclage for the treatment of inferior pole patella fracture: A retrospective comparative study. J Orthop Surg Res 2025;20:504. DOI: 10.1186/s13018-025-05926-6.
  5. Lefaivre KA, O'Brien PJ, Broekhuyse HM, Guy P, Blachut PA. Modified tension band technique for patella fractures. Orthop Traumatol Surg Res 2010;96:579-82. DOI: 10.1016/j.otsr.2010.01.014.
  6. Zhang Y, Xu Z, Zhong W, Liu F, Tang J. Efficacy of K-wire tension band fixation compared with other alternatives for patella fractures: A meta-analysis. J Orthop Surg Res 2018;13:226. DOI: 10.1186/s13018-018-0919-6.
  7. Burvant JG, Thomas KA, Alexander R, Harris MB. Evaluation of methods of internal fixation of transverse patella fractures: A biomechanical study. J Orthop Trauma 1994;8:147-53. DOI: 10.1097/00005131-199404000-00012.
  8. Handoll HH, Gillespie WJ, Gillespie LD, Madhok R. The Cochrane Collaboration: A leading role in producing reliable evidence to inform healthcare decisions in musculoskeletal trauma and disorders. Indian J Orthop 2008;42:247-51. DOI: 10.4103/0019-5413.41849.
  9. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): Development and validation of a new instrument. ANZ J Surg 2003;73:712-6. DOI: 10.1046/j.1445-2197.2003.02748.x.
  10. Chiang CC, Chen WM, Jeff Lin CF, Chen CF, Huang CK, Tzeng YH, et al. Comparison of a minimally invasive technique with open tension band wiring for displaced transverse patellar fractures. J Chin Med Assoc 2011;74:316- 21. DOI: 10.1016/j.jcma.2011.05.008.
  11. Drolia N, Sinha S, Paneru SR, Kumar A, Jameel J, Kumar S, et al. Comparison of functional and radiological outcomes of transverse patellar fractures fixed with tension band fixation using cannulated screws and Kirschner wires: A prospective randomized study. Indian J Orthop 2021;56:369- 76. DOI: 10.1007/s43465-021-00498-z.
  12. Hoshino CM, Tran W, Tiberi JV, Black MH, Li BH, Gold SM, et al. Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires. J Bone Joint Surg Am 2013;95:653-9. DOI: 10.2106/JBJS.K.01549.
  13. Lin T, Liu J, Xiao B, Fu D, Yang S. Comparison of the outcomes of cannulated screws vs. modified tension band wiring fixation techniques in the management of mildly displaced patellar fractures. BMC Musculoskelet Disord 2015;16:282. DOI: 10.1186/s12891-015-0719-7.
  14. Liu C, Ren H, Wan C, Ma J. Comparison of the therapeutic effects of tension band with cannulated screw and tension band with Kirschner wire on patella fracture. Comput Math Methods Med 2020;2020:4065978. DOI: 10.1155/2020/4065978.
  15. Liu J, Ge Y, Zhang G, Zheng X, Gao L, Xing E, et al. Clinical outcomes of cannulated screws versus ring pin versus K-wire with tension band fixation techniques in the treatment of transverse patellar fractures: A case-control study with minimum 2-year follow-up. Biomed Res Int 2022;2022:5610627. DOI: 10.1155/2022/5610627.
  16. Poh JW, Li Z, Koh DTS, Tay KXK, Goh SK, Woo YL, et al. Cannulated compression screws with cable technique leads to a dramatic reduction in patella fracture fixation complications compared to tension band wiring. Arch Orthop Trauma Surg 2024;144:4333-41. DOI: 10.1007/s00402-024-05533-w.
  17. Tan H, Dai P, Yuan Y. Clinical results of treatment using a modified K-wire tension band versus a cannulated screw tension band in transverse patella fractures: A strobe-compliant retrospective observational study. Medicine (Baltimore) 2016;95:e4992. DOI: 10.1097/MD.0000000000004992.
  18. Tian Y, Zhou F, Ji H, Zhang Z, Guo Y. Cannulated screw and cable are superior to modified tension band in the treatment of transverse patella fractures. Clin Orthop Relat Res 2011;469:3429-35. DOI: 10.1007/s11999-011-1913-z.
  19. Wang CX, Tan L, Qi BC, Hou XF, Huang YL, Zhang HP, et al. A retrospective comparison of the modified tension band technique and the parallel titanium cannulated lag screw technique in transverse patella fracture. Chin J Traumatol 2014;17:208-13.
  20. Zhu XZ, Huang TL, Zhu HY, Bao BB, Gao T, Li XW, et al. A retrospective cohort study on prevalence of postoperative complications in comminuted patellar fractures: Comparisons among stabilized with CannulatedScrew, Kirschner-Wire, or Ring-Pin Tension Bands. BMC Musculoskelet Disord 2021;22:60. DOI: 10.1186/s12891-020-03936-5.
  21. Kfuri M, Escalante I, Schopper C, Zderic I, Stoffel K, Sommer C, et al. Comminuted patellar fractures: The role of biplanar fixed angle plate constructs. J Orthop Translat 2020;27:17-24. DOI: 10.1016/j.jot.2020.10.003.
  22. Zhang ZS, Li PF, Zhou F, Tian Y, Ji HQ, Guo Y, et al. Comparison of a novel tension band and patellotibial tubercle cerclage in the treatment of comminuted fractures of inferior pole of the patella. Orthop Surg 2020;12:224-32. DOI: 10.1111/os.12616.
  23. Melvin JS, Mehta S. Patellar fractures in adults. J Am Acad Orthop Surg 2011;19:198-207. DOI: 10.5435/00124635-201104000-00004.
  24. Sousa PL, Stuart MJ, Prince MR, Dahm DL. Nonoperative management of minimally displaced patellar sleeve fractures. J Knee Surg 2021;34:242-6. DOI: 10.1055/s-0039-1694742.
  25. Loudon JK. Biomechanics and pathomechanics of the patellofemo-ral joint. Int J Sports Phys Ther 2016;11:820-30.
  26. Bonnaig NS, Casstevens C, Archdeacon MT, Connelly C, Monaco N, Wyrick JD, et al. Fix it or discard it? A retrospective analysis of functional outcomes after surgically treated patella fractures comparing ORIF with partial patellectomy. J Orthop Trauma 2015;29:80-4. DOI: 10.1097/BOT.0000000000000201.
  27. Benjamin J, Bried J, Dohm M, McMurtry M. Biomechanical evaluation of various forms of fixation of transverse patellar fractures. J Orthop Trauma 1987;1:219-22. DOI: 10.1097/00005131-198701030-00004.
  28. Berg EE. Open reduction internal fixation of displaced transverse patella fractures with figure-eight wiring through parallel cannulated compression screws. J Orthop Trauma 1997;11:573-6. DOI: 10.1097/00005131-199711000-00005.
  29. Baid M, Narula S, Manara JR, Blakeney W. Evolution in the management of Patella Fractures. J Clin Med 2024;13:1426. DOI: 10.3390/jcm13051426.
  30. Berninger MT, Korthaus A, Eggeling L, Herbst E, NeumannLangen MV, Domnick C, et al. Analysis of postoperative complications 5 years after osteosynthesis of patella fractures-a retrospective, multicenter cohort study. Eur J Trauma Emerg Surg 2024;50:1691-9. DOI: 10.1007/s00068-024-02503-0.
  31. Maden M, Bayraktar OB, Bacaksiz T, Akan I, Uzun B, Kazimoglu C. Does protruding headless cannulated screw reduce fixation stability in tension band wiring technique for patella fractures? A biomechanical study. J Orthop Surg Res 2025;20:148. DOI: 10.1186/s13018-025-05567-9.