Kneecap Fractures (Patella Fractures): Treatment Options

Kneecap Fractures (Patella Fractures): Treatment Options

This video will review treatment options for patella fractures, also called kneecap fractures. The type of patella fracture and whether the extensor mechanism of the knee is affected will guide a health care provider in choosing the best treatment option. Nonsurgical treatment is typically used for patella fractures that are nondisplaced and that do not impact the function of the extensor mechanism. This means that the broken bone pieces have not moved out of place, and that the other parts of the extensor mechanism, which include the quadriceps muscles, quadriceps tendon, and patellar tendon that all work together to straighten the knee, are not injured or affected.

In these cases, the knee is immobilized in a knee brace in 10° of bending, an almost fully straightened position with a very slight bend in the knee. Gentle bending of the knee is often started about 2 weeks later, gradually progressing to more and more bending over the course of about 6 weeks. This helps to prevent the knee from getting stiff while avoiding too much stress to the kneecap as it is healing. During this time, weight-bearing is encouraged and the patient should stand and walk on the affected leg while wearing the knee brace. An assistive device, like crutches or a walker, is often used in the beginning to help with balance. During this time, a health care provider will monitor healing of the kneecap with x-rays. About 90% of cases show good results when treatment is properly followed. Further physical therapy is usually needed after this time to improve range of motion, strength, and balance.

Surgical treatment is recommended for patella fractures that are displaced and/or that affect the extensor mechanism. The most commonly performed technique is called tension band fixation, where metal wires or sutures are used to hold the broken bone pieces together. Other techniques are also available, including using metal screws and a metal plate and screws. If other parts of the extensor mechanism were also affected, additional surgery may be needed to repair the structures. Patients will then need to attend physical therapy for several weeks after surgery to restore the function of the knee.

While both nonsurgical and surgical treatment options have good outcomes, complications such as knee stiffness, decreased ability to fully straighten the knee, and osteoarthritis of the kneecap can result from a patella fracture. Proper rehabilitation, which includes early weight-bearing and range of motion, can decrease these complications. This means that patients should walk and gently bend the knee as much as possible when the surgical team allows to maintain the function of the knee as a fracture heals. Sometimes the metal hardware used to stabilize a patella fracture can be irritating, so additional surgery may be done to remove it later on.

In summary, the type of patella fracture will determine the type of treatment needed. Fractures that are nondisplaced and that do not affect the extensor mechanism can be treated nonsurgically. This involves wearing a knee brace and weight-bearing and knee bending early on, followed by physical therapy. Surgery is recommended for fractures that are displaced and/or affect the extensor mechanism. Wires, sutures, plates, and/or screws can be used to fix a patella fracture, followed by physical therapy to restore knee function. Proper rehabilitation can minimize complications.