Patellar fractures are associated with substantial postoperative morbidity, and traditional tension-band wiring has been linked with high complication rates and suboptimal functional outcomes. Locking plate fixation is a newer surgical option that offers superior biomechanical stability in laboratory and biomechanical assessments. The trial reported here set out to compare clinical outcomes between locking plate fixation and tension-band wiring in adults requiring operative treatment for displaced patellar fractures.
This was a multicentre, patient- and assessor-blinded randomized controlled trial. A total of 122 adults with displaced patellar fractures were randomized in a 1:1 ratio to receive either locking plate fixation or tension-band wiring. Analyses were performed according to the intention-to-treat principle. The report provides completion rates for the 12-month follow-up visit: 57 of 63 patients randomized to locking plate fixation completed 12-month follow-up (90.5%), while 52 of 59 patients randomized to tension-band wiring completed 12-month follow-up (88.1%). The publication is listed in Bone Joint J (2026 Sep 1;108-B(9):1182–1189) with PMID 42674573 and DOI 10.1302/0301-620X.108B9.BJJ-2026-0517.R1.
The primary outcome was patient-reported knee function measured by the five subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 12 months. The trial pre-specified a superiority criterion: a statistically significant difference in at least three KOOS subscales, with differences exceeding predefined minimal clinically important differences for each subscale. The MCIDs applied were: pain 10 points, symptoms 9 points, activities of daily living (ADL) 6 points, sport and recreation 10 points, and quality of life (QoL) 10 points.
At 12 months, locking plate fixation produced statistically significant and clinically meaningful improvements in three KOOS subscales compared with tension-band wiring. The reported mean differences (locking plate minus tension-band wiring) and 95% confidence intervals were:
These differences met or exceeded the trial’s MCID thresholds for the respective subscales and were statistically significant. The abstract indicates that three KOOS subscales met the superiority definition, which fulfills the predefined criterion for superiority in this trial.
The trial listed additional clinical and functional outcomes as secondary endpoints and recorded adverse events and reoperations. The abstract explicitly states that removal of hardware, failure of fixation, and reoperation occurred more frequently (the text is truncated at this point in the provided source). Specific numbers, rates, statistical comparisons, or other secondary outcome data are not available in the excerpt supplied. Therefore, precise incidence rates, the magnitude of increased risk, and details about the timing or causes of reoperation or hardware removal cannot be restated here because they were not reported in the source content provided.
Within the 12-month follow-up reported in the abstract, locking plate fixation yielded superior patient-reported knee function on three KOOS subscales—symptoms, sport and recreation, and quality of life—relative to tension-band wiring, with differences that were both statistically significant and clinically meaningful according to the trial’s predefined MCIDs. These findings suggest that locking plates may offer improved functional recovery in selected patients with displaced patellar fractures.
Clinicians should weigh these functional benefits against the trial’s note that hardware removal, fixation failure, and reoperations were reported as occurring more frequently (details not provided in the excerpt). Decisions about fixation method should therefore consider both the potential for better patient-reported outcomes and the possibly higher rates of subsequent procedures or device-related complications, pending full review of the complete published data.
The present rewrite is based solely on the abstract content available in the provided source. Several important trial details were not included in that excerpt and therefore cannot be inferred or reported here. Missing information includes:
Readers should consult the full text of the published trial (Bone Joint J. 2026;108-B(9):1182–1189; DOI 10.1302/0301-620X.108B9.BJJ-2026-0517.R1) for complete data on complication rates, secondary outcomes, operative details, and any additional analyses that inform risk–benefit assessment.