Fracture of the patella (kneecap)
What is it?
A fracture of the patella refers to a break in the kneecap bone.
How does it happen?
The kneecap is typically fractured following a direct blow to the front of the knee. It may also be fractured with a strong contraction of the quadriceps muscle on the front of your thigh. Contraction of this muscle places increased force on your kneecap. If these forces are great enough, your kneecap can break.
How does it feel?
The first sensation felt when the kneecap is fractured is immediate and intense pain over the front of the knee. This pain may worsen with movement of the knee joint or tightening of the thigh muscle. The pain is frequently strong enough to cause you to limp and, in some instances, may be so intense that you are unable to put any weight through the injured leg at all. If the kneecap has a complete break in it, the broken pieces of bone may move on one another. This may give the front of the knee a different appearance to normal. An altered appearance may also result from swelling around the injury. Swelling may occur quickly (i.e. within the first 1–2 hours) or overnight.
What should you do?
A patella fracture represents a serious knee injury. If you suspect a patella fracture it is advised you cease your activity or sport, begin initial treatment and seek immediate medical attention. Initial treatment involves immobilizing the knee as soon as possible using splints and bandages. You may raise the injured knee above the level of the heart once immobilized to help reduce pain and swelling.
What shouldn’t you do?
If you have or suspect you have fractured your kneecap, you shouldn’t perform any activities which may cause the broken ends of the bone to move on one another. To achieve this, you shouldn’t use or bend the injured leg until it has been assessed by a sports medicine professional. In addition, you should avoid any activities which may increase blood flow to the injured area. These include hot showers, heat rubs, massage and the consumption of alcohol. These may increase bleeding and swelling around the broken ends of bone and potentially prolong your recovery.
Could there be any long-term effects?
Most fractures of the kneecap heal without complication in a matter of weeks. However, a proportion of injuries can result in longer-term effects depending on the severity of the injury and extent of damage. Injury may also occur to the cartilage lining the undersurface of the kneecap and the tissues which support the kneecap. Injury to these structures may delay recovery. A delayed recovery may occur if the broken ends of bone fail to join back together. In addition to prolonging your recovery, injury to the underlying cartilage can also increase your chance of developing arthritis within the knee in later life.
The assistance of a sports medicine professional is important in the treatment of a fractured kneecap. Initially, they can assist in diagnosing the injury and the extent of the damage. Imaging techniques such as an X-ray, CT scan or MRI may be of benefit. From this, they can estimate how long the injury is expected to take to heal and determine an appropriate treatment program. This may involve using crutches, wearing a splint or brace and, in some cases, surgery to hold the broken pieces of bones together. During your recovery, the sports medicine professional will also be able to give you a series of exercises designed to facilitate your recovery and reduce the risk of secondary injury when you return to your activity or sport.