9 studies (2 RCTs, 6 case-controlled studies and 1 review), comparing the incidence of anterior knee pain following intramedullary nailing of tibial shaft fractures using either a patella tendon splitting (PTS) or a medial para-patellar (MPP) approach, met the inclusion criteria for this study. Among these studies, 6 qualified for meta-analysis. The purpose of this study was to determine whether one approach was associated with a higher incidence of anterior knee pain. Upon analysis, it was determined that there was no significant increase in risk for anterior knee pain associated with one technique over the other.