The patella, more commonly known as the kneecap, is more than just a small bone in the front of your knee. Without it, movements like kicking, running and jumping will be impossible to do. Every time you bend or straighten your knee, the patella is gliding over the front of your knee joint, and this ensures smooth movement. A patella fracture will change the whole dynamic of how your knee moves. And it’s easier to sustain a broken kneecap than you think. In 70% of cases, the kneecap is fractured by simply falling directly on the front of your knee. 

The Patella Bone

Often referred to as the kneecap, your patella is a small, triangle-shaped bone that sits at the front of your knee. You can think of it as a protective cover for the front of your knee. The knee joint is called the tibiofemoral joint, because it is formed by the femur (thigh bone) and tibia (shin bone). The patella sits in front of the femur (thigh bone) and slides over it when you move your knee, forming the patellofemoral joint. Underneath your patella, there is a layer of smooth cartilage. This cartilage improves movement like the lubricant in a well-oiled machine, preventing any unwanted friction or wear and tear.

Tendons and Ligaments

Picture the patella as a ship anchored in a harbor. Tendons and ligaments are the ropes that keep it securely in place. The most important of these is the patellar tendon, which connects the bottom of the patella bone to the top of the shinbone.

The medial Patellofemoral ligament is also an important rope that keeps your patella from moving too far to the outside of your knee.

The Power Booster

When you decide to kick a soccer ball, your kneecap is at the forefront. It acts like a lever, amplifying the force that your quadriceps creates. This means you can kick harder and run faster, all thanks to this small bone.

The Protector

Imagine wearing a helmet while riding a bike. The helmet shields your head from any potential harm. In the same way, the patella is a protective shield for the knee joint. It takes the brunt of any direct impact.

The Smooth Operator

Every time you bend or straighten your knee, the patella glides over the joint.  Can you imagine the amount of fricion over that spot? If it wasn’t for the kneecap, the quadriceps tendon would have had to endure all the friction. Luckily, the patella is covered in cartilage and fits snugly into a groove in the femur and thus it gives your knee  smooth and friction-free movement.

The Balancer

The patella doesn’t work alone. Together with the patella tendon and surrounding ligaments, they ensure that your knee is stable. Especially while you walk down stairs, run, jump, twist or dance.

The Impact

Imagine you take a misstep and fall directly onto your knee. This sudden force directly targets your kneecap. Because the patella is such a superficial bone, the impact on it is much worse. Thus, it can easily “crack under pressure”.

The Break

When the force is too strong, the bone structure of the kneecap breaks into pieces. This is what we refer to as a patella fracture. If the bones move apart from each other, we call this a “Displaced” fracture. If there is just a crack in the patella, we call this a “Non-Displaced” fracture.

Leg’s Position

The way the fracture happens can be different based on how your leg was positioned during the impact. For instance, if your leg was straight and took a direct hit, the fracture might be different than if your knee was bent. The angle that the patella is hit from will also determine how the patella breaks.

Future Issues

Once fractured, the knee becomes more vulnerable. Without proper treatment and healing, it can lead to persistent pain, and the knee might not function as smoothly as before, making certain movements challenging or painful. Other knee conditions can develop because the muscles around the knee might compensate, and this can ultimately lead to a patellar tendonitis or bursitis.

• Sudden contractions (pulling) of the quadriceps muscle that causes the tendon to pull on the kneecap and break it apart
• Falling directly onto your knee: As simple as stumbling forward and hitting your knee on something hard.
• Sport: Like hockey or cricket where your knee could be hit directly with a ball, bat or stick.
• Car accidents: Where the knee hits the dashboard directly.
• Rapid quadriceps contraction: A sudden jump, sprint or kick will require a strong quadriceps contraction. This can be enough to crack or fracture your patella.
• Weak bone structure: Conditions like osteoporosis weakens your bone structure and can make you more prone to fractures, even with a small impact.

1. Stress fractures and undisplaced fractures:

Cracks or breaks in the kneecap are called undisplaced fractures when the pieces of bone have not shifted out of place.

2. Displaced Fractures:

A step up in severity, displaced fractures occur when the bone breaks into two or more pieces, causing them to move out of alignment. This misalignment means the broken pieces have shifted and no longer line up correctly with each other. If you have a displaced fracture, you’ll likely experience increased pain and noticeable swelling around the knee area. Due to the nature of this fracture, surgery is often required. The procedure aims to realign the bone pieces, ensuring they heal correctly.

3. Comminuted Fractures (Severe):

Comminuted fractures are the most severe type, where the bone shatters into three or more pieces. Such fractures often result from high-impact injuries. The appearance of the knee might be deformed, and any movement can cause intense pain. Given the complexity of this break, surgery is almost always the recommended course of action. The goal is to meticulously fix the broken pieces, restoring the knee’s function and ensuring a smooth recovery.

As experienced physiotherapists, we want to assure you that we use a thorough and systematic approach to diagnose your patella fracture. Our goal is to accurately identify the source of your knee pain and create a treatment plan that fits in with your lifestyle.

To begin the diagnostic process, we take a detailed history of your symptoms. Next, we do a comprehensive physical examination of your knee. This includes:

• Palpation: Carefully examining the area around your knee to identify tenderness, swelling, or warmth. This can help to differentiate between inflammatory pain, muscle pain, tendon pain or joint pain.
• Range of motion assessment: Measuring the mobility of your knee, hip and ankle joints, as well as the flexibility of muscles surrounding your knee.
• Muscle Strength testing: It will be especially important to measure the muscle strength of your quadriceps muscle, as your patella is a part of its movement. But, other muscle groups will also be included in these tests.
• Special tests: Using specific clinical tests designed to provoke your symptoms. This is helpful to confirm the diagnosis of a patella fracture as well as differentiating between other conditions.

X-rays are the primary diagnostic tool for a patella fracture. They provide a clear image of the bones in your knee and can easily identify breaks or malalignment of the patella.

Your physiotherapist can refer you to get x-rays taken if necessary.

Ultrasound (sonar) is not effective to diagnose a patella fracture. However, it can detect areas of swelling and measure the integrity of soft tissue like muscles, tendons and ligaments.

If you need an ultrasound, your physio will refer you.

MRI is excellent for visualizing both bone and soft tissue injuries around the patella. It is not typically the first choice for bone fractures, but can detect bone bruises or hairline fractures missed by X-rays. An MRI may provide a detailed image, but is more expensive and you need a specialist referral to get one.

If your physiotherapist suspects that your injury needs an MRI, you will be referred to the right specialist.

The Domino Effect of a Fractured Patella

When you’ve fractured your patella, or kneecap, it’s not just about the broken bone. It’s about the whole environment around it. Imagine a bustling city street suddenly having a major roadblock. Traffic gets jammed, right? Similarly, a fracture negatively affects the normal flow of things in your knee.

The Cycle of Pain and Uncertainty

You might feel stuck in a loop of pain, unsure if moving will make things worse. This uncertainty can make you hesitant to use your knee, but avoiding movement isn’t always the answer. It’s like avoiding that busy street altogether instead of finding a way to remove the roadblock.

The Importance of Early Intervention

Getting the right treatment from the beginning is quite important. Think of it as calling in the experts to clear that roadblock efficiently. Without proper intervention, the tissues around the fracture don’t get a chance to heal correctly. It’s like the traffic jam becoming a regular feature, causing wear and tear on the surrounding roads.

Risks of Neglecting Treatment

If you ignore the signs and don’t seek treatment, you risk causing more severe, and sometimes permanent, damage. It’s like letting that road deteriorate without maintenance. Over time, it becomes unusable.

Why Natural Recovery Isn’t Enough

Simply put, a patellar fracture won’t just heal on its own. It needs attention, care, and the right approach to get back to its best. So, always listen to your body and seek professional advice when in doubt

Vicious Cycle of Pain

The discomfort from the fracture can make you hesitant to move your knee. This fear of pain leads to reduced movement, causing stiffness and muscle weakness, which in turn exacerbates the pain.

Misguided Treatment

If the initial treatment isn’t tailored to the specific needs of a Patella Fracture, it might not address the root cause, leaving you in continuous discomfort.

Deteriorating Tissue State

Without proper intervention, the damaged tissues don’t get a chance to heal correctly. This ongoing damage can lead to chronic inflammation and further deterioration of the knee joint.

Risk of Further Damage

Ignoring the pain or not seeking appropriate treatment can result in more severe, potentially irreversible damage. The fracture might lead to increased stiffness and weakness of the knee. This eventually leads to increased wear and tear and even Knee Osteoarthritis.

As experienced physiotherapists, we understand that Patella Fracture can be a painful and frustrating condition. We can assure you that together, we can create a treatment plan to guide you through recovery.

Our treatment plan will include a combination of techniques designed to reduce your pain and inflammation, and to improve your knee mobility and strength. Some of these techniques may include:

• Manual therapy: Hands-on techniques, like as soft tissue mobilization and joint mobilization, to help decrease your pain and increase your range of motion.
• Therapeutic exercises: We’ll work together on specific exercises to release and stretch the muscles around your knee to decrease pain.
• Knee Stabilization Exercises: The muscles in your knee, such as the Vastus Medialis and Popliteus, plays an integral role in knee movement. Exercises that stabilize the knee can help improve overall knee function.
• Activity modification: Initially, we guide you to modify your daily activities and exercise to minimize stress on your knee. This includes adjusting your exercise routine.
• Corrective exercises: We’ll work together on specific muscles to strengthen and provide endurance that your knee requires. These exercises will also aim to improve the mobility of your knee by stretching the joint capsule itself.
• Pain management and education: Giving you the information you need to understand your pain, helps with long-term pain relief. We can advise you on different pain-relief strategies.

Our goal is to help you get back to your normal daily life and exercise as soon as possible, while minimizing the chances of recurring injuries. Whether you have a goal to get back to the gym or simply want to play tennis without pain, we can help you get back to doing what you love.

Most Patellar Fractures can be divided into two categories – Displaced or Non-Displaced fractures. In other words, the management will depend on whether the patella was broken into pieces and the pieces are too far apart to heal on its own or whether it has a crack in the bone.

This is due to the natural process that needs to occur when your bones heal. The bone will first form a callous – which is a placeholder for the new bone to form in. This process usually happens within the first 6 weeks. Once the callous has formed, new bone will begin to grow into the area in the following 6 weeks.

Non-Displaced Fractures:

The healing time for a non-displaced fracture takes on average 3 months. This type of fracture does not require surgery if it is managed properly. Your knee will be placed in a brace that will keep the knee straight and you will be allowed to walk on the leg. The rehabilitation will begin almost immediately.

Displaced Fractures:

The majority of displaced fractures will require surgery as the bones will be too far apart to grow back together. Because the injury is more severe the healing time might take 3 – 4 months to heal depending on how well the treatment goes. Since this type of injury is more severe, it is likely that there are other injuries in the picture. The most common types of injuries that occur with a patella fracture include a knee dislocation, femur fracture as well as a hip fracture. This will significantly increase the time to full recovery because it makes the treatment more complicated.

After surgery, physiotherapy will begin immediately. Without physiotherapy, the outcomes of the surgery will be poorer since the knee will become weak and stiff and remain so. A comprehensive rehabilitation will be vital for a full recovery.

• Immobilisation

  : Typically, a cast or a knee brace helps to immobilise your knee while the broken kneecap heals. It’s non-invasive and has no surgical risks, but it leads to stiffness and muscle atrophy due to lack of movement.

• Medication and cortisone injections: Helps to manage pain and inflammation. It can be a useful tool in the healing process, but won’t be the only solution to the problem. If you’re managing a patella fracture with medication only, you are simply masking the symptoms to a bigger problem.
• Biokineticist: Physiotherapists and biokineticists often work together during a rehabilitation process. Seeing a biokineticist can definitely benefit you, especially towards the final phases of your recovery process and when you need help to return to your sport.
• Shockwave Therapy: Stimulates healing and reduces pain and inflammation. May cause discomfort during the treatment and is not suitable for all types of fractures.
• Ultrasound Bone Healing: Accelerates the healing process by stimulating cellular activity in the bone. Effectiveness may vary, and it won’t be suitable for severe fractures.

Before considering surgery, we have to first meet certain criteria to see if it will be appropriate:

• Non-surgical treatments have been tried and haven’t resulted in improvement.
• The patient is in good overall health and can undergo anesthesia and the surgical procedure.
• The benefits of the surgery outweigh the potential risks and complications.

The Surgery Journey:

Undergoing surgery is only the halfway mark to recovery. While the surgical procedure aims to fix the physical fracture, the post-surgical phase focuses on reintegration, strengthening, and adapting the body to the changes.

Types of Surgeries:

For patella fractures, the most common surgical procedures include:

• Open Reduction and Internal Fixation (ORIF): This involves realigning the fractured bone pieces and holding them together with screws, pins, or wires.
• Partial Patellectomy: In cases where a portion of the kneecap is severely damaged, it might be removed.
• Total Patellectomy: This is the removal of the entire kneecap, but it’s rare and only done if the kneecap is shattered beyond repair.

The Importance of Rehab After Surgery:

Rehabilitation post-surgery is incredibly important to make sure you make a full recovery. It helps to:

• Restore joint movement and muscle strength.
• Reduce post-operative pain and swelling.
• Accelerate the healing process by improving blood circulation to the operated area.
• Minimize the risk of post-surgical complications, such as stiffness or loss of function.
• Guide you in safely returning to your daily activities and, eventually, more strenuous tasks or sports.

• Patella tendinitis (Jumper’s Knee): Pain below the kneecap that worsens with running and jumping or repetitive knee movement. Unlike a fracture, there’s no history of trauma, but rather overuse.
• Patellar dislocation: While it might be caused by the same kind of trauma, a dislocation isn’t a break in the bone structure. The patella gets shifted out of place in a forceful way. Sometimes it can ‘pop’ back in by itself, whereas other times it needs to be manipulated back into place.
• Osgood-Schlatter disease: Common in growing adolescents, this condition involves pain and swelling just below the kneecap. The connection of the patella tendon onto the tibia is the main source of pain.
• Knee bursitis: Swelling in one or more of the bursae around your knee. Often due to overuse and friction. It leads to knee pain over the front of your kneecap or just below.

• Broken kneecap

• Kneecap fracture
• Cracked patella