To assess the prevalence of anterior knee pain more than 5 years after closed intramedullary nailing of the tibia and evaluate the long-term socioeconomic impact of this complication in terms of knee function and employment.

A retrospective, cohort study of 298 consecutive tibial intramedullary nailings in 295 patients. Minimum follow-up was 5 years and patients were assessed using a questionnaire and the Lysholm knee score. 26 patients are known to have died, 22 patients, greater than 60 years at the tune of their injury, were excluded, Thus, 251 knees in 248 patients were available for review.

The mean age at follow-up was 40. 8 years. The male to female ratio was SA:1 and mean follow-up was 7. 9 years. Anterior knee sensory disturbance was reported by 58% of patients. This interfered with activities of daily living (ADLs) in 29%, work in 25% and sport in 37%. Anterior knee pain was reported by 47% of patients. This interfered with ADLs in 37%, work in 36% and sport in 57%, Anterior knee pain was present all the time in 4%, often in 12%, sometimes in 27%, rarely in 21% and never in 37%, Pain on kneeling was rated on a visual analogue scale as mild in 54%, moderate in 34% and severe 12%. AKP improved with time in 73% patients and became worse in 4%. The Lysholm score rated 4 1 % knees as excellent, 19% as good, 26% as fair and 14% as poor. 86% of patients have been able to return to work, 9% are currently unemployed and 5% disabled. The presence of anterior knee pain was felt by the patient to prevent return to previous work in 10%.

Anterior knee pain persists in 47% of patients after intramedullary nailing of the tibia- There is some decrease in symptoms with time and the majority of patients are able to return to work and activities of daily living. However, anterior knee pain causes significant disability in a small number and all patients should be warned of this problem prior to surgery.