Patellar Fracture

with Rehab

Patellar fracture is a break in the kneecap (patella). These fractures may be complete or incomplete. It is common for injuries that cause a patellar fracture to also cause a tear (sprain) of the ligaments or ligament-like tissue (retinaculum), or a tear (strain) in the patellar tendon.

SYMPTOMS

  • Severe pain in the knee at the time of injury.

  • Tenderness and swelling in the knee.

  • Pain with movement of the knee.

  • Inability to straighten a bent knee, by its own power.

  • Catching or locking of the knee.

  • Bleeding and bruising (contusion) in the knee.

  • Difficulty bearing weight on the injured limb, especially when trying to get up from a sitting position, go up or down stairs, or jump.

  • Visible deformity, if the bone fragments are out of alignment (displaced).

  • Numbness and coldness in the leg and foot beyond the fracture site, if the blood supply is impaired.

CAUSES

Patellar fractures occur when a force is placed on the kneecap that is greater than it can handle. Common causes of injury include:

  • Direct trauma to the patella.

  • Indirect stress caused by twisting or bending.

RISK INCREASES WITH:

  • Contact sports (football, hockey, soccer).

  • Basketball.

  • Motor sports.

  • Bony abnormalities or diseases of the bone (osteoporosis, bone tumor).

  • Metabolism disorders, hormone problems, nutrition deficiencies and disorders (anorexia or bulimia).

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded protective equipment (knee pads).

PROGNOSIS

If treated properly, patellar fractures usually heal.

RELATED COMPLICATIONS

  • Fracture fails to heal (nonunion).

  • Fracture heals in a poor position (malunion).

  • Bone death (necrosis), due to interruption of blood supply to the bone.

  • Stopping of normal bone growth in children.

  • Risks of surgery: infection, bleeding, injury to nerves (numbness, weakness, paralysis), need for further surgery, and pain from the wires or screws used to fix the fracture.

  • Infection in the skin, broken over the fracture site (open fractures).

  • Arthritic knee joint.

  • Longer healing time, if activity is resumed too soon.

  • Proneness to repeated knee injury.

  • After healing, risk of roughened contact surface of the kneecap, causing pain with sitting, when rising from a sitting position, when going up or down stairs or hills, and when jumping or running.

  • Stiff knee.

  • Unstable kneecap.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. If the bone fragments are out of alignment (displaced), immediate realigning of the bone (reduction) by a person trained in the procedure is required. Fractures that cannot be realigned by hand, or are open (bones protrude through the skin), may require surgery to hold the fracture in place with screws, pins, and plates. Once the bone is in proper alignment, restraining the knee is often needed, to allow for healing. After restraint, it is important to perform strengthening and stretching exercises, to help regain strength and a full range of motion. These exercises may be completed at home or with a therapist.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • The following occur after restraint or surgery. (Report any of these signs immediately):

  • Swelling above or below the fracture site.

  • Severe, persistent pain.

  • Blue or gray skin below the fracture site or in the toes. Numbness or loss of feeling below the fracture site.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Patellar Fracture

Your fractured patella may be corrected with surgery and/or with a knee brace. Upon your caregiver's instructions, you may begin your rehabilitation with some of the following exercises. As you complete these, remember:

  • These initial exercises are intended to be gentle. They will help you restore motion without increasing any swelling.

  • Completing these exercises allows less painful movement and prepares you for the more aggressive strengthening exercises in Phase II.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION - Knee Flexion and Extension, Active-Assisted

  • Sit on the edge of a table or chair with your thighs firmly supported. It may be helpful to place a folded towel under the end of your right / left thigh.

  • Flexion (bending) : Place the ankle of your healthy leg on top of the other ankle. Use your healthy leg to gently bend your right / left knee until you feel a mild tension across the top of your knee.

  • Hold for __________ seconds.

  • Extension (straightening): Switch your ankles so your right / left leg is on top. Use your healthy leg to straighten your right / left knee until you feel a mild tension on the backside of your knee.

  • Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Knee Flexion, Active

  • Lie on your back with both knees straight. (If this causes back discomfort, bend your opposite knee, placing your foot flat on the floor.)

  • Slowly slide your heel back toward your buttocks until you feel a gentle stretch in the front of your knee or thigh.

  • Hold for __________ seconds. Slowly slide your heel back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH - Knee Flexion, Supine

  • Lie on the floor with your right / left heel and foot lightly touching the wall. (Place both feet on the wall if you do not use a door frame.)

  • Without using any effort, allow gravity to slide your foot down the wall slowly until you feel a gentle stretch in the front of your right / left knee.

  • Hold this stretch for __________ seconds. Then return the leg to the starting position, using your health leg for help, if needed.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH - Knee Extension Sitting

  • Sit with your right / left leg/heel propped on another chair, coffee table, or foot stool.

  • Allow your leg muscles to relax, letting gravity straighten out your knee.*

  • You should feel a stretch behind your right / left knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

*Your physician, physical therapist or athletic trainer may instruct you place a __________ weight on your thigh, just above your kneecap, to deepen the stretch.

STRETCH - Knee Extension, Prone

  • Lie on your stomach on a firm surface, such as a bed or countertop. Place your right / left knee and leg just beyond the edge of the surface. You may wish to place a towel under the far end of your right / left thigh for comfort.

  • Relax your leg muscles and allow gravity to straighten your knee. Your caregiver may advise you to add an ankle weight, if more resistance is helpful for you.

  • You should feel a stretch in the back of your right / left knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this __________ times per day.

*Your physician, physical therapist or athletic trainer may instruct you place a __________ weight on your ankle to deepen the stretch.

STRENGTHENING EXERCISES - Patellar Fracture

Regardless of whether your physician has stabilized your knee with surgery or a brace, he or she may have you begin some of the following exercises to rehabilitate your injury. The exercises may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided by your caregiver.

STRENGTH - Quadriceps, Isometrics

  • Lie on your back with your right / left leg extended and your opposite knee bent.

  • Gradually tense the muscles in the front of your right / left thigh. You should see either your kneecap slide up toward your hip or increased dimpling just above the knee. This motion will push the back of the knee down toward the floor, mat, or bed on which you are lying.

  • Hold the muscle as tight as you can, without increasing your pain, for __________ seconds.

  • Relax the muscles slowly and completely in between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Quadriceps, Short Arcs

  • Lie on your back. Place a __________ inch towel roll under your right / left knee, so that the knee bends slightly.

  • Raise only your lower leg by tightening the muscles in the front of your thigh. Do not allow your thigh to rise.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in 1 lb/0.5 kg increments.

STRENGTH - Quadriceps, Straight Leg Raises

Quality counts! Watch for signs that the quadriceps muscle is working, to be sure you are strengthening the correct muscles and not "cheating" by substituting with healthier muscles.

  • Lay on your back with your right / left leg extended and your opposite knee bent.

  • Tense the muscles in the front of your right / left thigh. You should see either your kneecap slide up or increased dimpling just above the knee. Your thigh may even shake a bit.

  • Tighten these muscles even more and raise your leg 4 to 6 inches off the floor. Hold for __________ seconds.

  • Keeping these muscles tense, lower your leg.

  • Relax the muscles slowly and completely between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hamstring, Isometrics

  • Lie on your back on a firm surface.

  • Bend your right / left knee approximately __________ degrees.

  • Dig your heel into the surface as if you are trying to pull it toward your buttocks. Tighten the muscles in the back of your thighs to "dig" as hard as you can without increasing any pain.

  • Hold this position for __________ seconds.

  • Release the tension gradually and allow your muscle to completely relax for __________ seconds between each exercise.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hamstring, Curls

  • Lay on your stomach with your legs extended. (If you lay on a bed, your feet may hang over the edge.)

  • Tighten the muscles in the back of your thigh to bend your right / left knee up to 90 degrees. Keep your hips flat on the bed.

  • Hold this position for __________ seconds.

  • Slowly lower your leg back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hip Extensors, Bridge

  • Lie on your back on a firm surface. Bend your knees and place your feet flat on the floor.

  • Tighten your buttocks muscles and lift your bottom off the floor until your trunk is level with your thighs. You should feel the muscles in your buttocks and back of your thighs working. If you do not feel these muscles, slide your feet 1-2 inches further away from your buttocks.

  • Hold this position for __________ seconds.

  • Slowly lower your hips to the starting position and allow your buttock muscles relax completely before beginning the next repetition.

  • If this exercise is too easy, you may cross your arms over your chest.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hip Abductors, Straight Leg Raises

Be aware of your form throughout the entire exercise, so that you exercise the correct muscles. Poor form means that you are not strengthening the correct muscles.

  • Lie on your side so that your head, shoulders, knee and hip line up. You may bend your lower knee to help maintain your balance. Your right / left leg should be on top.

  • Roll your hips slightly forward, so that your hips are stacked directly over each other and your right / left knee is facing forward.

  • Lift your top leg up 4 to 6 inches, leading with your heel. Be sure that your foot does not drift forward or that your knee does not roll toward the ceiling.

  • Hold this position for __________ seconds. You should feel the muscles in your outer hip lifting. (You may not notice this until your leg begins to tire.)

  • Slowly lower your leg to the starting position. Allow the muscles to fully relax before beginning the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Hip Abductors, Quadriped

  • On a firm, lightly padded surface, position yourself on your hands and knees. Your hands should be directly below your shoulders and your knees should be directly below your hips.

  • Keeping your right / left knee bent, lift your leg out to the side. Keep your legs level and in line with your shoulders.

  • Hold for __________ seconds.

  • Keeping your trunk steady and your hips level, slowly lower your leg to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Quadriceps, Squats

  • Stand in a door frame so that your feet and knees are in line with the frame.

  • Use your hands for balance, not support, on the frame.

  • Slowly lower your weight, bending at the hips and knees. Keep your lower legs upright so that they are parallel with the door frame. Squat only within the range that does not increase your knee pain. Never let your hips drop below your knees.

  • Slowly return upright, pushing with your legs, not pulling with your hands.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Plantar-flexors, Standing

  • Stand with your feet shoulder width apart. Steady yourself with a wall or table, using as little support as needed.

  • Keeping your weight evenly spread over the width of your feet, rise up on your toes.*

  • Hold this position for __________ seconds.

Repeat exercise __________ times, __________ times per day.

*If this is too easy, shift your weight toward your right / left leg until you feel challenged. Ultimately, you may be asked to do this exercise while standing on your right / left foot only.