Dealing With a Broken Kneecap
I Fell Down a Step and Fractured My Patella
Back in November 2011, I fell down a step and landed on my kneecap, shattering it into four pieces.
I had surgery to pin it back together and my leg was immobilized in a splint for six weeks.
The patella fracture healed, but the fun was just beginning. My knee joint was completely stuck due to scar tissue and severe muscle atrophy.
Since then, I've had more surgery to remove the hardware you can see in the photograph above.
This article is about the information I've discovered about patella fractures and what helps to rehabilitate this injury once it's fixed.
Everyone Is Different
From reading other people's experiences from the comments on this article and on the KneeGeeks Forum, it is clear to me that there is no definitive way to deal with a broken kneecap.
What works for some people does not necessarily work for others. It is important to remember that although we are all in the same boat with having a fractured patella, we are quite unique in our rehabilitation and ways to deal with it.
Treatment variations depend on individual factors such as age and general fitness, but more particularly, it depends on the locality and the methods applied by the medical staff responsible for your treatment.
It is important to remember when reading the experiences and advice shared on this page that your own situation may be different because of the above reasons.
Always check with your doctor before trying out new rehabilitation methods, as there may be a medical reason why it has not been suggested to you already.
Most importantly, don't worry or get disheartened if you read here that someone else has recovered from their patella fracture more quickly than you appear to be doing.
Different personal and medical factors mean that everyone will progress at different rates. Generally, the ways and means of getting to a particular place in your rehab will differ, but the overall timescale of your full recovery will be pretty much the same.
Keep working hard and you WILL get there!
Types of Patellar Fractures
Kneecap fractures come in many shapes and sizes! They range from a single crack to a break into several separated pieces. If the bone is cracked but the pieces stay in place, the treatment involves immobilizing the leg for about six weeks until the fracture is healed.
If the pieces are separated (displaced) then surgery is usually required to hold them together while it all heals back into place. My fracture was a comminuted displaced fracture . . . the one I would probably have not chosen if I could have picked. It means that my bone broke into several pieces and did not stay in place. You can see the arrangement of pins and wires used to fix my fracture in the X-ray at the start of this article.
So You Fractured Your Patella Too?
Patella fractures only make up about 1% of all bone breakages overall. I am curious to know which type of patella fracture are most common when they do occur. Check the names on the diagram above and select the relevant option below. Thank you for taking part in this poll.
Which type of patella fracture did you suffer?
Patellar Fractures — Everything You Need to Know
A YouTube video discussing types of patella fractures and their treatment.
My Knee Immobilizers: A Cast and a Splint
Following surgery, my leg was put in a "cylinder cast" for the first two weeks. After that, when my staples were removed, I was put in a velcro splint for another four weeks.
I've read that some patients are put in a hinge brace at two weeks which allows some movement of the knee joint to commence. I wonder if I'd had one of those maybe my knee would not have been stuck straight when the six weeks was up. I imagine early movement would have been painful, but worth it if it meant gaining a decent range of motion in a more reasonable time frame later.
Take the Immobilisers, Splints, Casts and Braces Poll!
Which did you get to help deal with a broken knee?
The Physioroom Elite Hinged Knee Brace
After six weeks in an immobiliser, my fracture had healed and the doctor told me to start walking without the splint, but my quads were practically non-existent and my physio told me they weren't strong enough to support my leg.
I was panic-stricken at the thought of walking without anything to help. I trawled the internet for advice about whether or not it was a good idea to progress to a small support brace and once I'd concluded that it was a good idea, the next thing was to decide which type would be best for me.
I decided that I needed a hinged brace which would allow me to alter the degree I could bend my knee. This would help to support my knee and stop it from bending too far and also allow for adjustment as my range of motion improved.
I decided on the Physioroom Elite Hinged Brace because it had adjustable hinges that could also be removed later, when I could cope with less support. The brace was also washable, so it would last a while, and it came in various sizes. I needed to measure around my knee at the widest part to select the correct size.
The brace slides up over my leg and has a velcro strap which wraps from the back of my knee and fastens over and above the joint to keep it securely in place. The adjustable velcro allows me to tighten or release it for a comfortable fit. The Elite also has a patella support, which is a reinforced ring inside the brace to stop the patella from tracking out of place and it is open to prevent overheating. We call it the knee donut!
I definitely needed the brace to help me start to walk again and still use it now for additional support when I'm driving or standing for a long time. I don't use the hinges anymore, and have removed them completely. It is possibly time for me to downgrade to a smaller support now, but I have worn it at least once a day for the last ten months now, so it has definitely been worth the money and I would recommend it to anyone considering getting a knee brace to help them through their patella fracture recovery.
Physioroom Elite Knee Brace Demo
"Better a broken bone than a broken spirit."— Lady Marjory Allen of Hurtwood
Gel Ice Packs Were Essential After Therapy Relief
If you are only going to buy one thing to see you through the physio regime, let this be it! They are just the best thing ever for cooling a raging knee joint and soothing the soreness and irritation.
I have the gel packs shown below. I got them back in January, just before I started my physio and they are still going strong. They come with a thin white pouch to place over them to save the cold from hurting your skin and they are flexible, even when frozen. I tend to leave mine in the fridge. That way they are always chilled when I need them.
Some Gentle Physio Knee Exercises
When my splint was removed after six weeks, my quads were totally wasted (atrophied) and my range of movement (ROM) in my joint was barely 20 degrees.
It took many weeks of gentle exercises, three or four times a day, to get them to wake up again. If you are going through this, don't be disheartened if all your hard work seems to be going nowhere. One day, your muscles WILL twitch, your leg WILL raise up in a straight lift and your knee WILL begin to bend again! Be patient, be determined, and you will get there.
Here are some of the exercises I did to kickstart my strength and movement. Start with five of each and build up to more when five gets too easy. There are many more quad-strengthening exercises, but your physio therapist will advise you which are safe for your particular injury.
Sitting or lying with both legs out straight, flex your foot back, push your knee down and tense your thigh muscles as tightly as possible. Hold for a few seconds then relax. Hold for longer when it becomes easier.
Inner Range Contractions / Short Arc Quads
Sit or lie with legs out straight. Roll up a towel or something similar (I used a soft pillow) and place it under your knee. Press your knee down into the towel and lift your heel at the same time. Try to get your leg out straight, keeping your knee on the towel as you do. Hold for five seconds and then slowly lower your heel back down.
Straight Leg Raises
Sit or lie with legs out straight. Flex your foot back, push the knee down into the floor to lock it straight, lift your heel and raise your leg about 12 inches from the floor, keeping the whole leg straight as you do. (This is very difficult to begin with. Don't be surprised if your leg feels like someone put a rock on it. Even if you can't manage to lift it at first, keep going through the motions, one day it will lift up!)
Heel Slides / Knee Bending
Start with legs out straight and slowly start to slide your heel along the floor towards your butt, as far as it will go. Hold for a few seconds, then straighten the leg back out. Repeat.
Prone Knee Bends
Lie face down with legs out straight. Keep your thigh down on the floor and bend your knee, lifting your foot back towards your butt as you go. It's trickier to do it this way as the muscles in your knee are tighter on the front.
Straight Leg Raise Exercises Video Demonstration
Watch how to correctly achieve the straight leg raise exercise in this YouTube video.
Pedal Exerciser — Helping to Push the Bend!
My physio therapy involves two main aspects - improving the muscle strength in my leg, and improving the range of motion (ROM) in my knee. The best method for improving the ROM I've found so far is using a static pedal exerciser.
The pedal exerciser allows me to sit down comfortably whilst working on my knee bend. Whilst I am unable to do a full rotation yet, I use the pedal on my good side to push back the bend in my bad leg. I can hold the tension for as long as I can bear it and ease off when I need to. The alternative exercise involves standing up at the bottom of the stairs with my bad leg up on the first step and leaning into the bend. This makes me feel a bit woozy and dizzy and I can't focus on working through the pain as well as I can when I'm sitting working on the pedals. My ROM has increased by 20 degrees in the four days I've been using the pedal exerciser at home ... definitely worth the investment!
Pedal Exerciser Demos on YouTube
Knee Massage — Do It While You View It!
Right from the start of my rehab, knee massage has been crucial. It helps loosen scar tissue inside the joint, keeps the external scar supple, encourages the muscles to wake up AND it soothes the pain during and after physio sessions.
I use E45 lotion or cream to massage my knee joint and I follow the routine in the video here for massage technique.
This video will take you through a step-by-step massage that really does help to loosen the joint and soothe the pain. It also has info about the knee joint and how it works.
E45 lotion has had multiple uses for my knee. It's been great for keeping the scar tissue moisturised without irritating it further with perfume. It's also great to massage the joint before and after therapy. I've found that massaging the joint helps to loosen it and eases some of the pain around the scar tissue.
How Did You Break Your Patella?
Most patella fractures happen as the result of a direct impact to the kneecap. Usually, this would take the form of a fall or forceful knock or blow. However, it is possible to fracture your patella by over-extension of the quad muscles with sudden and excessive force. For example, this sometimes happens to athletes when the sheer power in their muscles is enough to split the bone in two.
Let’s try to find out which is the more common way of fracturing your patella in this question poll. Thanks for taking part!
Please feel free to tell us more about how you got your patella injury in the comments below (with the exception of gory details of course, some of us haven’t eaten yet!).
How did you fracture your patella?
Broken Knee Resources That I've Found Useful on the Web
- My Broken Knee Story
My personal blog about my broken knee and the path to recovery.
- Knee Geeks Forum
Forum for people with knee injuries and problems
- Physio Room
A place to find info and resources for knee injury rehabiliation
Source of information sharing for all types of leg break injuries
- 5 Things to Know About a Patella Fracture
Useful info about patella fractures and what's involved in recovery
- Treatment of Patella Fractures
A more medical overview of the technical aspects of patella fractures and the methods used to treat them
Has This Information Helped You?
The information in this article is based on my own experiences and what I've found useful. What have I left out? Did I provide you with anything useful? Let me know in the comments below!
Questions & Answers
© 2012 Celticep