Addition of a McLaughlin cerclage to locking plate fixation of distal patellar pole fractures reduces interfragmentary displacement – a biomechanical human cadaveric study
- 1Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert- Schweitzer-Campus 1, 48149 Münster, Germany
- 2AO Research Institute Davos, Davos, Switzerland
- 3Institute of Metal Science, Equipment and Technologies with Hydro- and Aerodynamics Centre “Acad. A. Balevski”, Bulgarian Academy of Sciences, Sofia, Bulgaria
Abstract
Purpose: To investigate whether the addition of a McLaughlin cerclage to locking plate fixation of distal patellar pole fractures provides improved biomechanical construct stability and reduced interfragmentary displacement.
Methods: A distal patellar pole fracture was simulated in sixteen fresh-frozen human cadaveric knees by a horizontal osteotomy in the distal third of the patella. Subsequently, locking plate fixation was performed. In a randomized half of the specimens, an additional McLaughlin wire cerclage was applied. The specimens were then subjected to 3000 cycles of extension starting at 90° of flexion under a maximum tensile load of 320 N. Using a Digital Image Correlation (DIC) system, the interfragmentary displacement between the proximal and distal fragments was measured at 1, 10, 20, 30, 50, 100, 500, 1000, 2000, and 3000 cycles. Statistical analysis was performed using repeated-measures ANOVA and Welch’s unpaired t-t test at 3000 cycles.
Results: An additional McLaughlin cerclage significantly reduced interfragmentary displacement under cyclic loading in comparison to locking plate fixation alone. After 3000 cycles, displacement was 2.27 ± 1.84 mm with plate fixation alone and 0.36 ± 0.22 mm with additional McLaughlin cerclage (mean difference 1.91 mm; 95% CI 0.38–3.45 mm; p = 0.0215).
Conclusion: An additional McLaughlin cerclage reduced interfragmentary displacement in distal patellar pole fractures. In cases of unstable distal pole patella fractures, the additional use of a McLaughlin cerclage may therefore be considered to enhance construct stability.
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BibTeX
@article{deichsel2026addition,
title = {{Addition of a McLaughlin cerclage to locking plate fixation of distal patellar pole fractures reduces interfragmentary displacement – a biomechanical human cadaveric study}},
author = {Adrian Deichsel and Arian Große-Allermann and Klemens Horst and Christoph Kittl and Moritz Lodde and Boyko Gueorguiev and Ludmil Drenchev and Hristo K. Skulev and Elmar Herbst},
journal = {European Journal of Trauma and Emergency Surgery},
year = {2026},
month = oct,
doi = {10.1007/s00068-026-03380-5},
url = {https://doi.org/10.1007/s00068-026-03380-5},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Addition of a McLaughlin cerclage to locking plate fixation of distal patellar pole fractures reduces interfragmentary displacement – a biomechanical human cadaveric study
AU - Adrian Deichsel
AU - Arian Große-Allermann
AU - Klemens Horst
AU - Christoph Kittl
AU - Moritz Lodde
AU - Boyko Gueorguiev
AU - Ludmil Drenchev
AU - Hristo K. Skulev
AU - Elmar Herbst
PY - 2026
DA - 2026/10/27
JO - European Journal of Trauma and Emergency Surgery
DO - 10.1007/s00068-026-03380-5
UR - https://doi.org/10.1007/s00068-026-03380-5
AB - Purpose: To investigate whether the addition of a McLaughlin cerclage to locking plate fixation of distal patellar pole fractures provides improved biomechanical construct stability and reduced interfragmentary displacement. Methods: A distal patellar pole fracture was simulated in sixteen fresh-frozen human cadaveric knees by a horizontal osteotomy in the distal third of the patella. Subsequently, locking plate fixation was performed. In a randomized half of the specimens, an additional McLaughlin wire cerclage was applied. The specimens were then subjected to 3000 cycles of extension starting at 90° of flexion under a maximum tensile load of 320 N. Using a Digital Image Correlation (DIC) system, the interfragmentary displacement between the proximal and distal fragments was measured at 1, 10, 20, 30, 50, 100, 500, 1000, 2000, and 3000 cycles. Statistical analysis was performed using repeated-measures ANOVA and Welch’s unpaired t-t test at 3000 cycles. Results: An additional McLaughlin cerclage significantly reduced interfragmentary displacement under cyclic loading in comparison to locking plate fixation alone. After 3000 cycles, displacement was 2.27 ± 1.84 mm with plate fixation alone and 0.36 ± 0.22 mm with additional McLaughlin cerclage (mean difference 1.91 mm; 95% CI 0.38–3.45 mm; p = 0.0215). Conclusion: An additional McLaughlin cerclage reduced interfragmentary displacement in distal patellar pole fractures. In cases of unstable distal pole patella fractures, the additional use of a McLaughlin cerclage may therefore be considered to enhance construct stability.
SN - 1863-9933
SN - 1863-9941
ER -