Introduction: Several methods of transverse patellar fixation have been described. This study compares the clinical outcome and the occurrence of complications of various fixation methods. Sources of data: The databases PubMed,Web of Science, Science Direct, Google Scholar and Google were searched. Areas of agreement: A direct comparison between fixation techniques using mixed or non-metallic implants and metallic K-wire and tension band fixation shows no significant difference in clinical outcome between both groups. Additionally, studies reporting novel operation techniques show good clinical results. Areas of controversy: Studies describing the treatment of patients using nonmetallic or mixed implants are fewer compared with those using metallic fixation. Growing points: A large variety of clinical scoring systems were used for assessing the results of treatment, which makes direct comparison difficult. Areas timely for developing research: More data of fracture treatment using non-metallic or mixed implants is needed to achieve a more balanced comparison. © The Author 2013. Published by Oxford University Press. All rights reserved.