Experimental investigation of the tension band in fractures of the patella

We investigated the strain pattern developed in the anterior and posterior part of the fixed patella during knee motion. Eight fresh cadaver knees were used but two were excluded because of non reliable measurements due to misplacement of gauges. Two strain gauges were bonded in the midline of the anterior and two in the posterior surface of the patella. Threaded steel rods were cemented into the intramedullary femoral and tibial canals. The knee was placed on a special device. The quadriceps tendon was gripped and a 4.5 kg weight was attached to the tibial rod 16.5 cm distal to the joint line. Ten flexion/extension cycles were performed before testing. Initially the intact patella was tested. A transverse osteotomy was performed before being stabilized by the AO recommended tension band technique. The knee was retested again as above. Finally an additional circular wire was passed around the patella and the knee was tested again under the same loading configuration. The intact patella showed weak tensile strain on the anterior and compressive strain on the posterior surface through the range of knee motion. Tension band fixation produced weak tensile strains in the first few degrees of flexion and then weak compressive strains in the posterior surface. The presence of the additional circular wire significantly increased the compressive strain. The classical tension band is highly effective for the fixation of the fractured patella but is improved by an additional circular wire.