Flexion limitation after repair surgery for fractured patella

Patient

Q: Had knee surgery 8 months ago,broke my right patella,been in physio for 8 months and excersise at home and I still can't bend it over 75 degrees,specialist suggested a jas eeze brace,which I been useing for a month and I still don;t see that much improvement.They said my physio will be finished after one more session this week but I really want to bend more,I been working so hard but it still seems to stiffen up about an hr after I do my therapy,would you have any more suggestions that I could do at home or a gym,I am getting very frustrated I really want to bend a lot more,appreciate any help and thank you in advance,Mabel Cahoon

Doctor

A:   Usually the treatment of patellar fractures is determined by displacement. Non displaced fractures are typically treated without surgery (conservative treatment) by splinting the knee in extension (straight) for 4 to 6 weeks. Since the patella does not bear weight, there is no weight bearing restriction. Crutches, canes, or a walker may be used to aid in walking. Exercise of other leg muscles is encouraged while wearing the splint. After 4 to 6 weeks when the fracture is considered healed, physical therapy to regain range of motion is begun. In your case if you had a displaced fracture, then displaced fractures of the patella are treated surgically to stabilize the fragments. Metal pins, screws, wires, or plates may be used to hold pieces of bone together. Following surgery, the knee usually will be immobilized in a brace. Weight bearing and walking are permitted as tolerated as soon as possible after surgery. Exercises to strengthen important muscles of the leg are begun immediately and range of motion exercises are begun at 4 to 6 weeks after surgery. A healed fracture and a strong quadriceps muscle permit a return to vigorous activity in 6 months. Outcomes of surgery to repair displaced patellar fractures vary according to the type of fracture, other associated medical conditions, and the operative technique used. Partial excision of the patella may result in some loss of motion, but results appear to improve when as much of the original patella as possible is retained. Once the fracture is healed, exercises are continued until strength is restored in the knee joint, a normal gait is observed, and full function returns. A home program should be taught to complement supervised rehabilitation and to be continued after the completion of physical therapy. In the view that you have followed all of the above and still have some limitation I suggest to continue with occupational therapy and the exercise routine that you do at home. I also recommend an ergonomic assessment of your workplace and home to see if some adaptation may be done in order to help you with the recovery process.

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