Patellar (Kneecap) Fractures-OrthoInfo - AAOS Copyright 2017 American Academy of Orthopaedic Surgeons Patellar (Kneecap) Fractures A patellar fracture is a break in the patella, or kneecap, the small bone that sits at the front of your knee. Because the patella acts as a shield for your knee joint, it is vulnerable to fracture if you fall directly onto your knee or hit it against the dashboard in a vehicle collision. A patellar fracture is a serious injury that can make it difficult or even impossible to straighten your knee or walk. Some simple patellar fractures can be treated by wearing a cast or splint until the bone heals. In most patellar fractures, however, the pieces of bone move out of place when the injury occurs. For these more complicated fractures, surgery is needed to restore and stabilize the kneecap and allow for the return of function. Anatomy The patella is a small bone located in front of the knee joint — where the thighbone (femur) and shinbone (tibia) meet. It protects the knee and connects the muscles in the front of the thigh to the tibia.

The patella covers and protects the knee joint. The ends of the femur and the undersides of the patella are covered with a smooth substance called articular cartilage. This cartilage helps the bones glide easily along each other as you move your knee. Top of page Description The patella can fracture in many ways. A fracture may be a simple, clean, two-piece break or the bone can break into many pieces. A break can occur at the top, center, or lower part of the bone. Sometimes, fractures occur in more than one area of the kneecap. This x-ray of a knee taken from the side shows a patella that has been fractured in three places. Types of Patellar Fractures Stable fracture. This type of fracture is nondisplaced. The pieces of bone may remain in contact with each other or be separated by just a millimeter or two. In a stable fracture, the bones usually stay in place during healing. Illustration and x-ray show a vertical, stable fracture of the patella. Displaced fracture. In a displaced fracture, the broken ends of the bone are separated and do not line up correctly. The normally smooth joint surface may also be disrupted.

This type of fracture often requires surgery to put the pieces of bone back together. Illustration and x-ray show a front (left) and side (right) view of a two-part fracture across the patella (transverse fracture) with slight displacement between the broken pieces of bone. Comminuted fracture. In this type of fracture, the bone shatters into three or more pieces. Depending on the specific pattern of the fracture, a comminuted fracture may be either stable or unstable. A comminuted fracture of the patella. Open fracture. In an open fracture, the bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the bone. An open fracture often involves damage to the surrounding soft tissues and may take a longer time to heal. Open fractures are particularly serious because, once the skin is broken, there is a higher risk for infection in both the wound and the bone. Immediate treatment is required to prevent infection. Doctor Examination Physical Examination After discussing your symptoms and medical history, your doctor will examine your knee. The edges of the fracture can often be felt through the skin, particularly if the fracture is displaced. During the exam, your doctor will check for hemarthrosis.

In this condition, blood from the fractured bone ends collects inside the joint space, causing painful swelling. If you have a large amount of blood in your knee, your doctor may drain it to help relieve your pain. Your doctor will also order x-rays to help diagnose your fracture. The significant displacement of this patient's fracture has created a large gap between the pieces of bone. Reproduced from Ricci WM, Ostrum RE (eds.) Orthopaedic Knowledge Update: Trauma 5. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2016, pp:507-521. X-rays X-rays provide images of dense structures, such as bone. Your doctor will order x-rays from a number of different angles to look for a fracture and to view the alignment of the bones. This x-ray of a patellar fracture taken from the side shows significant displacement between the broken pieces of bone. Although rare, a person may be born with extra bones in the patella that have not grown together. This condition is called bipartite patella and it can be mistaken for a fracture. X-rays will help to identify bipartite patella.

Since many people have the condition in both knees, your doctor may take an x-ray of your other knee, as well. Treatment Nonsurgical Treatment If the pieces of bone are not out of place (displaced), you may not need surgery. Your doctor may apply a cast or splint to keep your knee straight and help prevent motion in your leg. This will keep the broken ends of bone in proper position while they heal. Depending upon your specific fracture, you may be allowed to bear weight on your leg while wearing a cast or brace. With some fractures, however, weight bearing is not allowed for 6 to 8 weeks. Your doctor will talk with you about restrictions on weight bearing. Surgical Treatment If the pieces of bone are out of place (displaced), you will most likely need surgery. Fractured patellar bones that are not close together often have difficulty healing or may not heal. The thigh muscles that attach to the top of the patella are very strong and can pull the broken pieces out of place during healing. Timing of surgery. If the skin around your fracture has not been broken, your doctor may recommend waiting until any abrasions have healed before having surgery.

Open fractures, however, have an increased risk of infection and are scheduled for surgery as soon as possible, usually within hours. During surgery, the cuts from the injury and the surfaces of the bone are thoroughly cleaned out. The bone will typically be repaired during the same surgery. Surgical Procedures The type of procedure performed often depends on the type of fracture you have. Before the surgery, your doctor will discuss your procedure with you, as well as any potential complications. Transverse fracture. These two-part fractures are most often fixed in place using screws or pins and wires and a "figure-of-eight" configuration tension band. The figure-of-eight band presses the two pieces together. This procedure is best for treating fractures that are located near the center of the patella. Fracture pieces at the ends of the kneecap are too small for this procedure. Breaks that are in many pieces can be overcompressed by the tension band. Another approach to a transverse fracture is to secure the bones using small screws or small screws and small plates. In this illustration and x-ray, a figure-of-eight tension band has been used to hold a transverse fracture together. Comminuted fracture.

In some fractures, the top or, more commonly, the bottom of the patella is broken into several small pieces. This type of fracture occurs when the kneecap is first pulled apart from the injury, and is then crushed when the patient falls on it. Because the bone fragments are too small to be fixed back into place, your doctor will remove them. He or she will then attach the loose patellar tendon back to the remaining patellar bone. If the kneecap is broken in many pieces at its center and the pieces are separated, your doctor may use a combination of wires and screws to fix it. Removing small portions of the kneecap that cannot be reconstructed may also have good results. Complete removal of the kneecap is a last resort in treating a comminuted fracture. Recovery Pain Management Most fractures hurt moderately for a few days to a couple of weeks. Many patients find that using ice, elevating the affected leg, and taking simple, non-prescription medications for pain relief are all that are needed to relieve pain. If your pain is severe, your doctor may suggest a prescription-strength medication, such as an opioid, for a few days.

Be aware that although opioids help relieve pain after surgery, opioid dependency and overdose has become a critical public health issue. For this reason, opioids are typically prescribed for a short period of time. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Rehabilitation Whether your treatment is surgical or nonsurgical, rehabilitation will play a vital role in getting you back to your daily activities. Because treatment for a patellar fracture can sometimes require keeping your leg immobilized in a cast for a long period of time, your knee may become stiff and your thigh muscles may become weak. During rehabilitation, your doctor or a physical therapist will provide you with specific exercises to help: Improve range of motion in your knee Strengthen your leg muscles Decrease stiffness Weight Bearing Your doctor will tell you when you can begin to bear weight on your leg. Initial weight-bearing exercise is usually limited to gently touching your toe to the floor. As your injury heals and your muscles strengthen, you will gradually be able to put more weight on your leg. Even after successful treatment, some patients with patellar fractures may experience long-term complications. Posttraumatic Arthritis Posttraumatic arthritis is a type of arthritis that develops after an injury.

Even when your bones heal normally, the articular cartilage covering the bones can be damaged, leading to pain and stiffness over time. Severe arthritis occurs in a small percentage of patients with patellar fractures. Mild to moderate arthritis—a condition called chondromalacia patella—is much more common. Muscle Weakness Some patients may have permanent weakness of the quadriceps muscle in the front of the thigh after a fracture. Some loss of motion in the knee, including both straightening (extension) and bending (flexion), is also common. This loss of motion is not usually disabling. Chronic Pain Long-term pain in the front of the knee is common with patellar fractures. While the cause of this pain is not completely understood, it is likely that it is related to posttraumatic arthritis, stiffness, and muscle weakness. Some patients find that they are more comfortable wearing a knee brace or support. Top of page Outcome How long it takes to recover after a patellar fracture will depend upon a number of factors, including: The severity of your injury Whether your treatment was surgical or nonsurgical The time needed for rehabilitation Most patients will be able to return to their normal activities within 3 to 6 months.

For patients with severe fractures, the return to activity may take longer. Your doctor may suggest some lifestyle changes to help protect your knee and prevent future problems. This may include avoiding activities that involve repetitive deep knee bending or squatting. Climbing stairs or ladders should be avoided, as well. Top of page For More Information If you found this article helpful, you may also be interested in Fractures (Broken Bones) Fractures (Broken Bones) (topic.cfm?topic=A00139). Patella Injuries and Kneecap Pain - Diagnosis and Treatment Prolonged sitting Kneeling Kneecap problems can be diagnosed on physical examination by a skilled clinician. Sometimes kneecap pain can be difficult for an individual to describe. Often the symptoms occur around the kneecap, but often people will feel it "deep" inside the knee or even in the back of the knee. Your physical examination may include specific tests and maneuvers that cause compression to the cartilage on the back of the kneecap to help determine if those provoke your symptoms of pain. Tests often performed to diagnose kneecap problems include x-rays, MRIs, and other tests.

In addition, some surgeons may use injections to help determine the source of the pain (and possibly also for a treatment, too). There are several common problems associated with the kneecap that can cause problems and pain in the knee: The most common disorder is known as chondromalacia, often called Runner's Knee. Chondromalacia occurs because of irritation of the cartilage on the undersurface of the kneecap. Patellar tendon tears are serious injuries when the tendon connecting the kneecap to the shin is ruptured. Recovery takes at least 4-6 months, possibly longer for return to sports. Treatment of Kneecap Problems Treatment of these various kneecap conditions depends on the diagnosis, however there are some general guidelines that can be followed. For more information, and for a diagnosis of your knee pain, it is important to see your doctor. Rest Resting the injured knee to allow time for inflammation to subside is very important. Cross-training will allow you to keep in shape. When you do return to activity, do so gradually. Knee Problems and Knee Injuries Overview A Knee Problems and Injuries - Topic Overview Most people have had a minor knee problem at one time or another.

Most of the time our body movements do not cause problems, but it's not surprising that symptoms develop from everyday wear and tear, overuse, or injury. Knee problems and injuries most often occur during sports or recreational activities, work-related tasks, or home projects. The knee is the largest joint in the body. The upper and lower bones of the knee are separated by two discs ( menisci ). The upper leg bone (femur) and the lower leg bones (tibia and fibula) are connected by ligaments , tendons , and muscles. The surface of the bones inside the knee joint is covered by articular cartilage, which absorbs shock and provides a smooth, gliding surface for joint movement. See a picture of the structures of the knee . Although a knee problem is often caused by an injury to one or more of these structures, it may have another cause. Some people are more likely to develop knee problems than others. Many jobs, sports and recreation activities, getting older, or having a disease such as osteoporosis or arthritis increase your chances of having problems with your knees . Injuries are the most common cause of knee problems.

Sudden (acute) injuries may be caused by a direct blow to the knee or from abnormal twisting, bending the knee, or falling on the knee. Pain, bruising, or swelling may be severe and develop within minutes of the injury. Nerves or blood vessels may be pinched or damaged during the injury. The knee or lower leg may feel numb, weak, or cold; tingle; or look pale or blue. Acute injuries include: Sprains , strains , or other injuries to the ligaments and tendons that connect and support the kneecap. A tear in the rubbery cushions of the knee joint ( meniscus ). Knee Pain From Plica Syndrome By Jonathan Cluett, MD - Reviewed by a board-certified physician. Updated December 24, 2016 Plica syndrome, sometimes called "synovial plica syndrome ," is a condition of irritation of the tissue that is the inner lining of the knee joint. Synovium is the type of tissue that forms the lining a joint. The synovial tissue contains the joint space and helps to make the normal fluid that lubricates the joint. The synovial plica are membranes that separate the knee into compartments during fetal development.

These plica bands normally shrink in size during the second trimester of fetal development. In adults, they exist as sleeves of tissue called "synovial folds," or plica. In some individuals, the synovial plica is more prominent and prone to irritation. There is really no known function of a plica, it is simply a leftover anatomic variation that exists in some people and not in others. Plica Syndrome The plica on the inner side of the knee, called the medial plica, is the synovial tissue most prone to irritation and injury. When the knee is bent, the medial plica is exposed to direct injury, and it may also be injured in overuse syndromes . When the plica becomes irritated and inflamed, the condition called plica syndrome results. Diagnosis of plica syndrome is made by physical examination or at the time of arthroscopic surgery. Plica syndrome has similar characteristics to meniscal tears and patellar tendonitis , and these conditions may be confused.

The most common signs of plica syndrome include: Knee pain on the inner side of the joint Tenderness directly over the medial plica Swelling and warmth around the plica Snapping and clicking when the knee is bent X-rays of the knee are typically normal in a patient with plica syndrome. An MRI may be done to help with the diagnosis, but this test is not a perfect method to diagnose this condition. Treatment of Plica Syndrome Plica syndrome is best treated by resting the knee joint and allowing inflammation to subside. Treatments to reduce inflammation include ice application and anti-inflammatory medications . These measures are usually sufficient to allow the irritated plica to settle down. Occasionally, an injection of cortisone into the knee will be helpful. If these measures do not alleviate the symptoms, then surgical removal of the plica may be necessary. This surgical procedure is performed using arthroscopic knee surgery , or a small camera, that is inserted into the knee along with instruments to remove the inflamed tissue. The arthroscopic plica resection has good results assuming the plica is the cause of the symptoms. Often a plica is seen on arthroscopic examination .

Unless the patient's symptoms are consistent with plica syndrome, and the plica looks inflamed and irritated, the plica is usually left alone. Plica resection during arthroscopy is only performed if the plica is thought to be the source of symptoms. Is It Even a Problem? There is controversy as to whether or not plica syndrome even exists. Many people have a plica, and some seem to have pain in that location while others do not. Some doctors believe that the plica band can be a source of pain while others feel that the pain is likely resulting from another problem such as patellofemoral pain syndrome, or a meniscus tear. Most surgeons agree that while synovial inflammation can be a source of possible knee pain, it is relatively uncommon and should only be considered the source of pain when other, more common conditions have been excluded. Certainly, efforts to manage the symptoms with nonsurgical treatments should be attempted before considering surgery to address this condition. Source: Anterior knee pain: MedlinePlus Medical Encyclopedia Standing up after sitting for awhile Exams and Tests The health care provider will perform a physical exam. The knee may be tender and mildly swollen.

Also, the kneecap may not be perfectly lined up with the thigh bone (femur). When you flex your knee, you may feel a grinding feeling below the kneecap. Pressing the kneecap when the knee is straightening out may be painful. Your provider may want you to do a single leg squat to look at muscle imbalance and your core stability. X-rays are very often normal. However, a special x-ray view of the kneecap may show signs of arthritis or tilting. MRI scans are rarely needed. Treatment Resting the knee for a short period of time and taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin may help relieve pain. Other things you can do to relieve anterior knee pain include: Change the way you exercise. Learn exercises to both strengthen and stretch the quadriceps and hamstring muscles. Learn exercises to strengthen your core. Lose weight (if you are overweight). Use special shoe inserts and support devices (orthotics) if you have flat feet. Tape your knee to realign the kneecap. Wear the correct running or sports shoes. Rarely, surgery for pain behind the kneecap is needed.

During the surgery: Kneecap cartilage that has been damaged may be removed. Changes may be made to the tendons to help the kneecap move more evenly. Outlook (Prognosis) Anterior knee pain often improves with a change in activity, exercise therapy, and the use of NSAIDs. When to Contact a Medical Professional Call your health care provider if you have symptoms of this disorder. Alternative Names Patellofemoral syndrome; Chondromalacia patella; Runner's knee; Patellar tendinitis; Jumper's knee Images References Collado H, Fredericson M. Patellofemoral pain syndrome. Clin Sports Med. 2010;29:379-98. PMID: 20610028 . De Carlo M, Armstrong B. Rehabilitation of the knee following sports injury. Clin Sports Med. 2010;29:81-106. PMID: 19945588 . Tan EW, Cosgarea AJ. In: Miller MD, Thompson SR eds. Patellar instability. DeLee and Drez's Orthopaedic Sports Medicine. 4th ed.

Philadelphia, PA: Elsevier Saunders; 2014:chap 104. Silverstein JA, Moeller JL, Hutchinson MR. Common issues in orthopedics. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 30. Read More Dislocation Review Date 10/24/2014 Updated by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Related MedlinePlus Health Topics Patellar Tendon Tear-OrthoInfo - AAOS Copyright 2016 American Academy of Orthopaedic Surgeons Patellar Tendon Tear Tendons are strong cords of fibrous tissue that attach muscles to bones. The patellar tendon works with the muscles in the front of your thigh to straighten your leg. Small tears of the tendon can make it difficult to walk and participate in other daily activities.

A large tear of the patellar tendon is a disabling injury. It usually requires surgery and physical therapy to regain full knee function. Anatomy The patellar tendon attaches the bottom of the kneecap (patella) to the top of the shinbone (tibia). It is actually a ligament that connects to two different bones, the patella and the tibia. The patella is attached to the quadriceps muscles by the quadriceps tendon. Working together, the quadriceps muscles, quadriceps tendon and patellar tendon straighten the knee. The knee and tendons Description Patellar tendon tears can be either partial or complete. Partial tears. Many tears do not completely disrupt the soft tissue. This is similar to a rope stretched so far that some of the fibers are frayed, but the rope is still in one piece. Complete tears. A complete tear will disrupt the soft tissue into two pieces. When the patellar tendon is completely torn, the tendon is separated from the kneecap. Without this attachment, you cannot straighten your knee. The patellar tendon often tears at the place where it attaches to the kneecap, and a piece of bone can break off along with the tendon.

When a tear is caused by a medical condition — like tendinitis — the tear usually occurs in the middle of the tendon. A complete tear of the patellar tendon Injury A very strong force is required to tear the patellar tendon. Falls. Direct impact to the front of the knee from a fall or other blow is a common cause of tears. Cuts are often associated with this type of injury. Jumping. The patellar tendon usually tears when the knee is bent and the foot planted, like when landing from a jump or jumping up. Tendon Weakness A weakened patellar tendon is more likely to tear. Several things can lead to tendon weakness. Patellar tendinitis. Inflammation of the patellar tendon, called patellar tendinitis, weakens the tendon. It may also cause small tears. Patellar tendinitis is most common in people who participate in activities that require running or jumping. While it is more common in runners, it is sometimes referred to as "jumper's knee." Corticosteroid injections to treat patellar tendinitis have been linked to increased tendon weakness and increased likelihood of tendon rupture. These injections are typically avoided in or around the patellar tendon. Chronic disease.

Weakened tendons can also be caused by diseases that disrupt blood supply. Chronic diseases which may weaken the tendon include: Chronic renal failure Infection Metabolic disease Steroid use. Using medications like corticosteroids and anabolic steroids has been linked to increased muscle and tendon weakness. Surgery Previous surgery around the tendon, such as a total knee replacement or anterior cruciate ligament reconstruction, might put you at greater risk for a tear. Top of page Symptoms When a patellar tendon tears there is often a tearing or popping sensation. Pain and swelling typically follow, and you may not be able to straighten your knee. Additional symptoms include: An indentation at the bottom of your kneecap where the patellar tendon tore Bruising Tenderness Cramping Your kneecap may move up into the thigh because it is no longer anchored to your shinbone Difficulty walking due to the knee buckling or giving way Doctor Examination Medical History and Physical Examination Your doctor will discuss your general health and the symptoms you are experiencing. He or she will also ask you about your medical history. Questions you might be asked include: Have you had a previous injury to the front of your knee? Do you have patellar tendinitis?

Do you have any medical conditions that might predispose you to a knee or a patellar tendon injury? Have you had surgery to your knee, such as a total knee replacement or an anterior cruciate ligament reconstruction? After discussing your symptoms and medical history, your doctor will conduct a thorough examination of your knee. To determine the exact cause of your symptoms, your doctor will test how well you can extend, or straighten, your knee. While this part of the examination can be painful, it is important to identify a patellar tendon tear. Doctors use the knee extension test to help diagnose a quadriceps tendon tear. Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010. Imaging Tests To confirm the diagnosis, your doctor may order some imaging tests, such as an x-ray or magnetic resonance imaging (MRI) scan. X-rays. The kneecap moves out of place when the patellar tendon tears. This is often very obvious on a "sideways" x-ray view of the knee. Complete tears can often be identified with these x-rays alone. MRI.

This scan creates better images of soft tissues like the patellar tendon. The MRI can show the amount of tendon torn and the location of the tear. Sometimes, an MRI is required to rule out a different injury that has similar symptoms. (Left) This x-ray taken from the side shows the normal location of the kneecap. (Right) The kneecap has moved out of place due to a torn patellar tendon. Reproduced and adapted from J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003. Your doctor will consider several things when planning your treatment, including: The type and size of your tear Your activity level Very small, partial tears respond well to nonsurgical treatment. Nonsurgical treatment most often includes wearing a brace and physical therapy. Courtesy Thinkstock © 2016 Immobilization. Your doctor may recommend you wear a knee immobilizer or brace. This will keep your knee straight to help it heal. You will most likely need crutches to help you avoid putting all of your weight on your leg. You can expect to be in a knee immobilizer or brace for 3 to 6 weeks. Physical therapy.

Once the initial pain and swelling has settled down, physical therapy can begin. Specific exercises can restore strength and range of motion. While you are wearing the brace, your doctor may recommend exercises to strengthen your quadriceps muscles. Straight-leg raises are often prescribed. As time goes on, your doctor or therapist will unlock your brace. This will allow you to move more freely with a greater range of motion. You will be prescribed more strengthening exercises as you heal. Surgical Treatment Most people require surgery to regain knee function. Surgical repair reattaches the torn tendon to the kneecap. People who require surgery do better if the repair is performed soon after the injury. Early repair may prevent the tendon from scarring and tightening into a shortened position. Hospital stay. Although tendon repairs are sometimes done on an outpatient basis, most people do stay in the hospital at least one night after this operation. Whether or not you will need to stay overnight will depend on your medical needs. The surgery may be performed with regional (spinal) anesthetic which numbs your lower body, or with a general anesthetic that will put you to sleep. Procedure. To reattach the tendon, sutures are placed in the tendon and then threaded through drill holes in the kneecap.

The sutures are tied at the top of the kneecap. Your surgeon will carefully tie the sutures to get the correct tension in the tendon. This will also make sure the position of the kneecap closely matches that of your uninjured kneecap. (Left) Sutures are passed through small holes that have been drilled into the kneecap. (Right) The sutures are tied at the top of the kneecap. Schottel P, Reinhardt KR, DiFelice GS, Ranawat AS: Surgical Treatment of Traumatic Quadriceps and Patellar Tendon Injuries of the Knee, in Flatow E, Colvin AC, eds: Atlas of Essential Orthopaedic Procedures. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2013, pp 137-145. New Technique. A recent development in patellar tendon repair is the use of suture anchors. Surgeons attach the tendon to the bone using small metal implants (called suture anchors). Using these anchors means that drill holes in the kneecap are not necessary. This is a new technique, so data is still being collected on its effectiveness.

Most orthopaedic research on patellar tendon repair involves the direct suture repair with the drill holes in the kneecap. Considerations. To provide extra protection to the repair, some surgeons use a wire, sutures, or cables to help hold the kneecap in position while the tendon heals. If your surgeon does this, the wires or cables may need to be removed during a later, scheduled operation. Your surgeon will discuss your need for this extra protection before your operation. Sometimes, surgeons make this decision for additional protection during surgery. It is then that they see the tendon shows more damage than expected, or the tear is more extensive. If your tendon has shortened too much before surgery, it will be hard to re-attach it to your kneecap. Your surgeon may need to add tissue graft to lengthen the tendon. This sometimes involves using donated tissue (allograft). Tendons often shorten if more than a month has passed since your injury. Severe damage from the injury or underlying disease can also make the tendon too short. Your surgeon will discuss this additional procedure with you prior to surgery. Complications. The most common complications of patellar tendon repair include weakness and loss of motion.

Re-tears sometimes occur, and the repaired tendon can detach from the kneecap. In addition, the position of your kneecap may be different after the procedure. As with any surgery, the other possible complications include infection, wound breakdown, a blood clot, or anesthesia complications. Rehabilitation. After surgery you will require some type of pain management, including ice and medications. About 2 weeks after surgery, your skin sutures or staples will be removed in the surgeon's office. Most likely, your repair will be protected with a knee immobilizer or a long leg cast. You may be allowed to put your weight on your leg with the use of a brace and crutches (or a walker). To start, your surgeon may recommend "toe touch" weight bearing. This is when you lightly touch your toe to the floor, putting down just the weight of your leg. By 2 to 4 weeks, your leg can usually bear about 50% of your body weight. After 4 to 6 weeks, your leg should be able to handle your full body weight. Over time, your doctor or therapist will unlock your brace. This will allow you to move more freely with a greater range of motion.

Strengthening exercises will be added to your rehabilitation plan. In some cases, an "immediate motion" protocol (treatment plan) is prescribed. This is a more aggressive approach and not appropriate for all patients. Most surgeons protect motion early on after surgery. The exact timeline for physical therapy and the type of exercises prescribed will be individualized to you. Your rehabilitation plan will be based on the type of tear you have, your surgical repair, your medical condition, and your needs. Complete recovery takes about 6 months. Many patients have reported that they required 12 months before they reached all their goals. Patellofemoral Pain Syndrome Patellofemoral Pain Syndrome Article by John Miller What is Patellofemoral Pain Syndrome? Patellofemoral pain syndrome is one of the most common knee complaints of both the young active sportsperson and the elderly. Patellofemoral pain syndrome is the medical term for pain felt behind your kneecap, where your patella (kneecap) articulates with your thigh bone (femur).

This joint is known as your patellofemoral joint Patellofemoral pain syndrome, is mainly due to excessive patellofemoral joint pressure from poor kneecap alignment, which in time, affects the joint surface behind the kneecap (retropatellar joint). What Causes Patellofemoral Pain Syndrome? Your patella normally glides up and down through the femoral groove. As your knee is bent, pressure between your kneecap and the groove increases. This retropatellar pressure is further increased if the patella does not ride normally through the groove, but “mistracks”, meaning it travels more to one side, making it rub against the femur. Repeated trauma causes an increase in your retropatellar joint forces, which can lead to kneecap pain, joint irritation and eventually degeneration of your patella joint surface. The most common causes of patellar malalignment are an abnormal muscle imbalance and poor biomechanical control. Aching kneecaps (patellofemoral pain) affect 25% of the population at some time in their lives but it is more common in athletes.

The sports where patellofemoral pain syndrome is typically seen are those when running, jumping and landing or the squatting position is required. Sports include running, tennis, netball, football, volleyball, basketball, skiing and other jumping sports. Untreated patellofemoral pain syndrome can also predispose you to patellar tendonitis . What Causes a Muscle Imbalance? Your quadriceps (thigh) muscles attach to the patella and through it to the patella tendon, which attaches to the top of your shin. If there is a muscle imbalance between the quadriceps muscles: vastus lateralis (VL), which pulls your patella up and outwards, and the vastus medialis oblique (VMO), which is the only quadriceps muscle that pulls your kneecap up and slightly in, then your patella will track laterally in the groove. Common reasons for a weak vastus medialis oblique (VMO) include knee injury, post-surgery, swelling or disuse. Longstanding tightness of your lateral knee structures (lateral retinaculum, VL, and ITB) will encourage your kneecap to drift sideways over time. Especially, if your VMO is also weak.

Patellofemoral pain syndrome is more common during adolescence, because the long bones are growing faster than the muscles, tendons and ligaments, putting abnormal stresses on the joints. Active children who do not stretch the appropriate muscles are predisposed to patellar malalignment. What Biomechanical Issues Cause Patellofemoral Pain Syndrome? Poor foot posture (eg flat feet) and weak hip control muscles can both allow your knee to abnormally twist and result in a lateral deviation of your patella. When poor biomechanics are repeated with each step of your walking or running pattern that poor habit repeatedly traumatises your patellofemoral pain. What are the Symptoms of Patellofemoral Pain Syndrome? The onset of your kneecap pain is normally gradual rather than traumatic. Patellofemoral pain symptoms are normally noticed during weightbearing or jarring activities that involve knee bending. Stairs, squatting, kneeling, hopping, running or using stairs are commonly painful. As your patellofemoral pain syndrome progresses your knee will become painful while walking and then ultimately even at rest. You can also experience kneecap pain when you are in sustained knee bend eg. sitting in a chair.

A nickname for this condition is “theatre knee”. Patellofemoral Pain Syndrome Treatment Researchers have confirmed that physiotherapy intervention is a very effective short and long-term solution for kneecap pain. Approximately 90% of patello-femoral syndrome sufferers will be pain-free within six weeks of starting a physiotherapist guided rehabilitation program for patellofemoral pain syndrome. For those who fail to respond, surgery may be required to repair associated injuries such as severely damaged or arthritic joint surfaces. The aim of treatment is to reduce your pain and inflammation in the short-term and, then more importantly, correct the cause to prevent it returning in the long-term. There is no specific time frame for when to progress from each stage to the next. Your injury rehabilitation will be determined by many factors during your physiotherapist’s clinical assessment. You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves. It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and the frustration of a delay in your recovery.

Phase 1 - Injury Protection: Pain Relief & Anti-inflammatory Tips As with most soft tissue injuries the initial treatment is - Rest, Ice and Protection. (Active) Rest: In the early phase your best to avoid all activities that induce your kneecap pain. Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Protection: Your physiotherapist will normally apply kinesiology supportive taping or similar to help relieve your pain and commence your patellofemoral joint realignment phase. The patellofemoral taping is normally immediately effective in providing you with pain relief. Your physiotherapist will utilise a range of helpful tricks including pain relieving techniques, joint mobilisations, massage, strapping and acupuncture to assist you during this painful phase. Anti-inflammatory medication and natural creams such as arnica may help reduce your pain and swelling. Most people can tolerate paracetamol as a pain reliever. Phase 2: Regain Full Range of Passive Motion Your kneecap and knee must be able to glide through its full normal range of motion.

Your physiotherapist will assess your motion and apply the necessary techniques to normalise your range of motion. Phase 3: Restore Full Muscle Length Your thigh, hamstring and calf muscles will require stretching is they are tight and are causing excessive tension or pressure on your kneecap. It is important to regain normal muscle length to improve your lower limb biomechanics. Phase 4: Normalise Quadriceps Muscle Balance In order to prevent a recurrence, your quadriceps muscle balance and its control should be assessed by your physiotherapist. In most instances you will require a specific knee strengthening program. Your physiotherapist will prescribe the best exercises for you. Phase 5: Normalise Foot & Hip Biomechanics Patellofemoral pain syndrome can occur from poor foot biomechanics (eg flat foot) or poor hip control. In order to prevent a recurrence, your foot and hip control should be assessed by your physiotherapist. In some instances you may require a foot orthotic (shoe insert) or you may be a candidate for the Active Foot Posture Stabilisation program. Other patient may require a hip stabilisation program. Your physiotherapist will happily discuss what you require.

Phase 6: Normalise Movement Patterns Kneecap pain commonly occurs from poor habits, whether they be an abnormal gait, jumping, landing, running or squatting technique. In order to prevent a recurrence, your walking pattern, jumping and landing technique, running style or squatting method should all be assessed and corrected as required. Your physiotherapist will happily discuss what you specifically require. Phase 7: Restore High Speed, Power, Proprioception and Agility Most kneecap pain sufferers need to return to high speed or repetition activities, which place enormous forces on your knee. Your physiotherapist will guide you in your return to sport planning. Balance and proprioception (the sense of the relative position of neighbouring parts of the body) are both known to be adversely affected by patellofemoral pain. To prevent a re-aggravation, both aspects need to be assessed and retrained. Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepare you for light sport-specific training.

Phase 8: Return to Sport If you play sport, and depending on the demands of your chosen sport, you may require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport. Your physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete and safe return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury. Fractured Kneecap - Cedars-Sinai Fractured Kneecap Print The kneecap (the patella) is a triangular bone at the front of the knee. Several tendons and ligaments connect to the kneecap, including ones attached to the upper leg (femur) and lower leg (tibia) bones. Though the kneecap is not needed for walking or bending your leg, it makes your muscles more efficient and absorbs much of the stress between the upper and lower portions of the leg. Climbing stairs and squatting can put up to seven times your normal body weight on the kneecap and the joint behind it.

The kneecap can fracture in many ways: partially or completely or into only a few or into many pieces. Sometimes when the kneecap is fractured, the ligaments or tendons attached to it can be sprained or torn. Symptoms Severe pain in and around the kneecap Swelling Pain when moving the knee in both directions Difficulty extending the leg or doing a straight-leg raise A deformed appearance of the knee due to the fractured pieces Tenderness when pressing on the kneecap Causes and Risk Factors for a Fractured Kneecap In most cases, a broken kneecap is caused by a direct blow to the front of the knee from a car accident, sports or a fall onto concrete. Kneecap fractures account for about 1% of all skeletal injuries. Most kneecap fractures are suffered by people between the ages of 20 and 50. Diagnosis A doctor can often diagnose a fractured kneecap by asking you about the details of your accident and examining you. Your doctor will look at your knee, focusing on where it is tender, swollen or misshapen.

Your doctor may also ask you to raise your leg or extend your knee, possibly after giving you a local anesthetic to eliminate pain. This helps him or her see if there are other injuries in and around your knee. X-rays, taken from several angles, are the best way to find out the extent of a fractured kneecap and to check for other injuries. If other injuries are suspected, a computer tomography (CT) or magnetic resonance imaging (MRI) scan may be done. Treatments Two types of surgery may be done to repair a fractured kneecap: Open reduction-internal fixation (ORIF) surgery - The surgeon opens the skin and puts the broken bones back together with metal wires, pins or screws. Broken pieces of bone too small to be fixed are removed. If the kneecap is so severely fractured that it cannot be repaired, it may be partially or totally removed. After the bones have been joined, the opening is closed, a sterile dressing is put over the area and the knee is put in a cast or other device so it cannot move while it heals. Sometimes, especially in patients who are thin, the wires, pins or screws can be irritating.

If so, the devices will be removed after your kneecap has fully healed. Full or partial patellectomy - This two-hour procedure removes all or part of the kneecap. If your surgeon finds that the break is too severe to repair, he or she will remove the damaged pieces of bone. The surgery preserves the quadriceps tendon above the kneecap, the patellar tendon below and other soft tissues around the kneecap. After this surgery, you will be able to extend your knee, but the strength of the extension will be weaker. Once your kneecap has healed, making the muscles around your knee stronger can help avoid further injury. Playing contact sports or doing other activities that put stress on your knee can increase the risk of having another injury to the kneecap. You should avoid these activities or use a kneepad to cushion the blow when playing contact sports. Physical therapy , learning ways to spare your knee stress and strengthening and conditioning your leg muscles on an on-going basis can help prevent more injuries to the knee. Your best exercise options are low-impact and non-weight-bearing, like stationary bikes and certain weightlifting programs, so that the knees do not have to absorb shock.

Question: In everyday English, what is your patella?
Answer: Kneecap