Background and Etiology

The knee is the largest joint in the body. It is built for weight bearing, stability and mobility. The knee complex is composed of four bones and three osseous bone-to-bone joints. The four bones in the knee are the tibia or lower leg bone or shin, the patellar or kneecap, the femur or thighbone, and the fibula a long thin bone in the lower leg. A patellar fracture is a break to the kneecap.

A fracture is defined as a partial or complete crack in a bone. Fractures can be minor with little or no displacement of the bone, or more severe with complete displacement of the two ends of the bone that requires surgery to realign. There are closed fractures that do not break the skin, and open fractures that do break the skin.

The most common cause of a patellar fracture is trauma from a direct blow to the knee. Patellar fractures occur predominately in people who are 20-50 years old. Men are more likely than women to facture the patellar. Common causes of patellar fracture include:

  • Trauma from a fall or motor vehicle accident
  • Direct blow to the knee (for example, being kicked) perhaps during sports
  • Indirect trauma, for example violent contractions of the thigh muscles than can pull the patellar apart.

A fracture is an acute injury therefore a patient may begin to experience symptoms immediately.

  • Immobility when attempting to move the leg or knee
  • Severe loss of active motion of the knee.
  • Severe pain in the knee
  • Difficulty placing weight on the leg on the affected side
  • Stiffness, bruising or swelling at the knee
  • Weakness in the knee

In the event that an individual suspects they may have sustained a patellar fracture, a radiographic evaluation (X-Ray) will be essential to a proper diagnosis. Stable patellar fractures, where the ends of the bone still line up properly do not require surgery to heal. However, more severe patellar fractures where the ends of the bone do not line up correctly, the bone is broken into several pieces, or the surrounding tendons and ligaments are injured typically require surgery to realign and stabilize the injury.

How much movement should be restricted following the fracture will depend on the severity of the break. Once cleared by the physician, a physical therapy program should be initiated to restore knee motion. In more involved fractures recovery can be long and arduous. Formal therapy and compliance with an extensive home program is the mainstay to restoring function of the knee.

Goals for physical therapy post patellar fracture are increasing weight bearing as tolerated, restoration of normal tissue relationships to improve motion, strength and the ability to perform functional activities of daily living.

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, and joint mobilization by a physical therapist to modulate pain and reduce any soft tissue or tendon irritation and restore normal joint mechanics and range of motion.
  • Therapeutic Exercises (TE) including exercises to improve range of motion, strength and performance of the knee and surrounding muscles.
  • Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity, improve joint stability and improve movement technique and mechanics (for example: walking, stairs, squatting, and running) in use of the involved lower extremity in daily activities.
  • Modalities that can include the use of ultrasound, electrical stimulation, ice, cold and laser to decrease pain, improve mobility and reduce inflammation of the knee joint and surrounding muscles and tendons.
  • Home program development should include strengthening, stretching and stabilization exercises as well as instructions to help the person perform daily tasks and advance to the next functional level.

Most fractures can be diagnosed with X-Ray studies and when necessary a CAT scan. The use of pain medications, rest and ice are the first line of treatment. Surgical intervention is typically required to realign and repair severe patellar fractures.

Prognosis

Rate of recovery and the prognosis from a patellar fracture will depend on a number of factors:

  • Severity – Minor fractures do well with immobilization and physical therapy, while fractures that are more severe and require surgery or effect joint integrity take longer to recover. Patients may have residual motion and strength deficits.
  • Age- Younger individuals recover faster and are less likely to have residual deficits. Younger individuals heal quicker, have better circulation, are stronger and usually their pre-injury tissue integrity is better.
  • Prior activity level plays an important role in post-injury recovery. Those who exercise regularly are stronger and more flexible, and generally have an easier and more complete recovery.
  • Compliance- Patients that are committed to their rehabilitation program and are compliant with their home program are more successful in returning to full function.

Schedule an
Appointment!

Get back to doing what you love.

We are dedicated physical therapists that genuinely care. We strive to restore you to your former self, no matter the injury.

SCHEDULE APPOINTMENT

Real People, Real Testimonials.

"After my back surgery my doctor wanted me for physical therapy. He suggested Twin Boro Physical Therapy as one of the locations to go to. I checked out all the locations in the area and decided to go to Twin Boro. I stopped by on a Saturday but they were closed. Someone was at the desk doing paperwork and gave me all the information that i needed to fill out. She put the paperwork through and gave me a schedule to return on Monday for my first visit.The therapist ( Andrew ) examined me an put me through a series of work outs three times a week along with his daily exam. As each exercise became easier I was given something a little harder. They were slowly building up the strength in my lower back, core, legs and arms. After years of back pain I am now able to begin to get back to a normal life. I had a chance to work with other therapist there, they are all fantastic and there to help us return to a healthy life. The entire staff is was a pleasure to work with. They listen to what you have to say and and pay attention to what you said. I looked forward to going there, the staff was caring, kind and funny at times. I would highly recommend Twin Boro for physical therapy."

Victor S.

"The therapists and staff at the Twin Boro in North Brunswick truly place their patients first. My six month experience at this office was outstanding. Coming to Twinboro, I was unsure of my diagnosis, but with the help and dedication of my therapist Ivana, answers were found and exercises were set in place to treat my symptoms. Ivana made coming to therapy an enjoyable experience with her attention to detail, compassion, and sociability. It was evident through the environment Ivana created for that she listens to her patients and makes decisions with the best interest of the patient in mind. If you need to attend physical therapy and are in the area, Twin Boro in North Brunswick is the right choice!"

Sarah K.

“I loved being a patient at your facility because your therapist went by my and the doctors needs. I was there not only at the old location in somerset but also I went to the new location to in North Brunswick, which I loved it was bigger and better. All of the therapist are so friendly and nice and treated you with respect. I was treated by not only Melvie but also Nick and both are so professional and gentle of the way they did my treatments. If I ever need to have physical therapy in the future I will definitely come back to your facility for you are very professional and well organized. I have been to other places but your facility beats them all.”

Christine

“Never having experienced physical therapy before, I had no idea what to expect. I feel so fortunate that my experience has been totally positive. Everyone helped me feel so welcome and comfortable. I feel that I am being challenged, but not too much. I feel that I make an improvement at each session.”

Tora

View all Testimonials

We have 23 convenient locations

We love being close to our patients. Find out which of our premier facilities is nearest you!

VIew a list of all locations