Surgery is sometimes needed to repair and stabilize the patella, or kneecap, after a fracture. Orthopedic surgeons at NYU Langone have the expertise to determine when surgery is the best option to restore knee function and which surgical technique is most appropriate.
Fractures that require surgery tend to be displaced fractures, meaning the patella has been broken into many different fragments that have separated from each other. In addition, surgery is typically scheduled immediately if any of the bone fragments have broken through the skin, called an open fracture. If the tendons or ligaments surrounding the fractured patella have been torn—including the quadriceps tendon, which covers the patella and connects the thigh muscles to the lower leg bone—surgery is also required.
For less severe fractures—or if there is significant swelling or bleeding at the site of the injury—surgery may be scheduled later. Your doctor provides you with a brace to immobilize the knee during this time and may also prescribe pain medication for a few days to help you remain comfortable.
For a fractured patella, NYU Langone doctors perform open reduction internal fixation surgery, a procedure to put the bone fragments back into place and stabilize the patella while it heals.
Open reduction internal fixation surgery has two components. First a surgeon makes an incision over the kneecap in order to see the pieces of broken bone and assess how well they can be put back together. If any bone fragments are too small to be put back into position, the surgeon may remove them.
In the second part of the procedure, a surgeon reassembles the pieces of the patella and fixes them into place using metal wires and or screws. These parts, made of stainless steel, stay in the body permanently and help keep the bones in place while they heal and grow back together. After the bones are fixed into place, the surgeon closes the incision with stitches or staples.
You are given general anesthesia before open reduction internal fixation surgery and typically return home the same day.
After surgery, a pain management specialist ensures sure you have medication to help you feel comfortable while the knee heals. A physical therapist visits before you leave the hospital to assess the range of motion of the repaired knee. You may be asked to get out of bed and walk while using crutches. Moving the knee soon after surgery helps to speed healing and prevent a complication, such as a blood clot that develops deep in a vein in the leg.
Before you leave the hospital, your doctor provides you with a knee splint to be worn for the first three to six days after surgery. This allows the incision to heal. A follow-up appointment with your surgeon occurs about one week after surgery, allowing the surgeon to check that the patella is healing appropriately. If you need crutches or a cane for balance, your doctor can provide you with the appropriate device.
If the patella was fractured into many pieces, or if a bone fragment extended through the skin, the knee may need to be immobilized in a cast or brace for an additional three to six weeks. Doctors also recommend additional immobilization for older people, whose bones may take longer to heal.
Doctors determine when your knee has healed well enough so that you can begin physical therapy—a vital part of recovery from a patella fracture. An NYU Langone physical therapist can tailor an exercise regimen to your needs. Physical therapy appointments usually continue twice a week for six weeks as you continue to build strength and put more weight on the knee.
Six weeks after the first follow-up visit, you meet with your surgeon again. If the bone has healed, you may be able to start walking without crutches. Physical therapy continues for another two to four weeks after that, or until the patella has healed enough that you don’t experience pain during low-impact physical activities.
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