Broken kneecap (fractured patella) Popoki tāwhatiwhati

A break usually happens because of a direct blow to the bone, such as falling onto a hard surface and landing on your knees.

A broken kneecap is a serious injury and often needs surgery. In the long term, it can cause arthritis in your knee.

Osteoarthritis

You may have broken your kneecap if:

• the front of your knee is painful and swollen
• you have bruising
• you cannot straighten your knee
• you cannot walk.

Your healthcare provider or physiotherapist will diagnose a broken kneecap. They will:

• listen to your explanation of what happened
• examine you
• look at an x-ray of your knee.

Whether or not you have surgery, there are some things you can do to make sure you recover as quickly and well as possible.

Make sure you follow the advice of your healthcare provider, physiotherapist or other health professional about rehabilitation and exercises. This is very important, as not following instructions may mean your broken kneecap:

• does not heal
• heals in the wrong position.

This can lead to continuing pain and further problems.

Keep your leg raised above your heart as much as possible for the first 24 to 48 hours and apply ice for 15 minutes every 4 to 5 hours.

If you smoke, stop smoking. Smoking affects how well your body can make new blood vessels, which reduces your chances of healing well.

Make sure you keep your wound and cast, if you have one, clean, dry and covered.

Take regular pain relief as recommended by your healthcare provider. Seek advice from them if you still have pain while taking the recommended pain relief. Do not take extra pain relief that has not been prescribed for you.

How your broken kneecap is treated depends on what the fracture looks like.

Treatment without surgery

If the break is stable (the bones do not move much) and you can fully straighten and raise your leg, you may be treated with a brace. This is called non-operative management.

The brace will limit the movement of your leg so the bones can heal.

It may be uncomfortable to put weight on your leg until the bone is completely healed, which may take 6 to 8 weeks or even longer. Some people use crutches during this time.

Using a pair of crutches

Treatment with surgery

If your fracture is unstable (meaning the bones could move around a lot), you might need surgery.

Surgery usually involves wires or, occasionally, screws to hold the broken kneecap together while it heals.

If the broken part of your kneecap is small, the surgeon may just remove the broken bit.

Very occasionally, a kneecap can be so badly broken that it cannot be repaired. If this happens, or if your surgery is not successful, your kneecap may be removed. It will not be replaced, so this only happens if there are no other options.

Recovery after surgery

Your leg will be in a brace after surgery, and it will stay on for 4 to 6 weeks. You will not be able to drive while your leg is in a brace.

You may have a small drain in place to stop fluid from building up around your injured knee immediately after surgery. This will be taken out after 24 hours.

Your nurse will regularly check the blood flow to your injured leg. They will also check how much pain you are feeling and give you pain relief. You may need to continue taking antibiotics.

You will see a physiotherapist, who will aim to get you moving as soon as possible. This helps to prevent problems that can happen with long periods of bed rest. These can include:

• blood clots in your leg (deep vein thrombosis)
• infections
• muscle weakness.

You will need some time off work. How long depends on:

• the particular operation you have
• what your job involves and whether there are any light duties you can do.

You will have some x-rays and regular appointments with your surgeon to check that the break is healing well.

If you have had wires to hold your bones together, you will likely have an operation to take them out. It is best to wait at least 3 months before getting the wires taken out.

Some people who have had screws put in their kneecap find them painful. If this happens to you, talk to your healthcare provider about a referral to have them removed. This is not usually done until 12 months after surgery to make sure the bone has healed completely.