Doctors can sometimes repair a fractured knee cap (patella) without surgery. This is possible when the fracture is not displaced, that is the pieces of the patella have not separated, and the quadriceps tendon, which covers the patella and connects it to the muscles of the thigh, is also intact. A fracture caused by stretching the knee to far, say, kicking a ball, or trying to jump too high, is more likely to result in a "clean break" than a compression injury to the knee caused by an outside force. Falls on the knee are also prone to cause compound fractures that require surgical repair.
Instead of surgery, your doctor and an orthotics specialist will fit you with a special cast that you will wear over your knee. This isn't something you can do on your own, because the device has to fit properly for your knee cap to grow back in good alignment. The cast keeps your leg immobile from the thigh to the shin. You won't be able to put weight on that leg for a week or two after the injury, so you will also be given crutches or a wheelchair to help you get around.
The doctor will probably take x-rays a week after your injury and every two weeks after that to monitor how well the bone in your knee is healing. Usually it takes six to eight weeks for your knee bone to heal well enough that the cast can be removed, although sometimes the process takes longer.
What else can your doctor do short of surgery on your knee?
- Electronic bone stimulation accelerates healing of the fracture. The doctor places one or more flat-disc electrodes near the break, and connects them to a machine that pulses electrical current through the patella. There is a portable version of this system that is used to control pain. The current is not strong enough to cause tissue damage; it's measured in milliamps. It's also not constant. Each pulse of electricity lasts only at most a thousandth a second (sometimes only one fifty-thousandth of a second), coming 100 times a second.
- Physical therapy also accelerates recovery of the knee. You aren't going to get physical therapy while it still hurts to move your knee. Doctors know that pain interferes with healing. However, as soon as activity is tolerable, you will be sent to a physical therapist who will direct you through exercises that strengthen your quadriceps muscles, which help to hold your patella in place, and load-bearing exercises to build other muscles around your knee. Your physical therapist will also help you with exercises to maintain the range of motion of your knee. It's usually best to work with a professional to do your rehab; you don't want to injure your knee again by doing too much too soon.
- Medications are also used to relieve pain, but there are two sets of problems that you will need to avoid. The first problem is with over the counter NSAID (non-steroid anti-inflammatory) medications such as aspirin, Ibuprofen, and Tylenol. These products relieve pain safely and with a minimum of side effects if you do not overdose them, but they also interfere with the growth of cartilage. If you have damaged your quadriceps they will impede your recovery. Opioid pain relievers are also effective against pain, but there is a real danger of dependency and addiction that you need to avoid. Better some temporary knee pain than a long-term, life-long, or life-ending problem with addiction.
It's important to get moving as soon as possible after your knee repair to prevent the formation of scar tissue that can permanently restrict your knee's range motion. It's equally important to avoid further damage to your patella. Following doctor's orders is a must for full recovery from patellar fractures.
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