Recovering from Patellar Fracture: Addressing Limited Knee Flexion

Patellar fracture recovery with inability to bend the knee?

I would like to ask the doctor: I had a car accident on May 8th and fractured my patella into two pieces.
After surgery, I was instructed to wear a knee brace that does not allow bending.
The doctor said on June 12th that I could stop wearing it while sleeping, but I still cannot bend it when getting out of bed.
As of July 1st, I can only bend it to 30 degrees, and bending it further causes pain.

1.
Is this joint stiffness?
2.
How can I increase the range of motion?
3.
Can I go to an external rehabilitation clinic?
4.
How long do I need to use the crutches and knee brace?
5.
Will this affect my ability to exercise in the future? Thank you, doctor.

Mr. Yang, 20~29 year old female. Ask Date: 2019/07/02

Dr. Li Yongheng reply Orthopedics

1.
Currently, there is joint stiffness.

2.
Engage in active rehabilitation or consult a surgeon for joint manipulation.

3.
You may visit an external rehabilitation clinic.

4.
Currently, you may not need to use crutches or a knee brace (please consult your surgeon first).

5.
If joint mobility does not improve, it will affect squatting and physical activity.

Reply Date: 2019/07/02

More Info

Recovering from a patellar fracture can be a challenging process, especially when it comes to regaining full range of motion in the knee. Based on your situation, where you experienced a patellar fracture that resulted in the bone splitting into two pieces, and considering the current limitations in knee flexion, let's address your questions systematically.

1. Is it joint stiffness?
The limited knee flexion you are experiencing, where you can only bend your knee to 30 degrees, could indeed be indicative of joint stiffness or rigidity. After a fracture, especially one that requires immobilization, it is common for the surrounding soft tissues, including ligaments and muscles, to become tight and less flexible. This stiffness can be exacerbated by prolonged use of a knee brace, which restricts movement and can lead to the formation of scar tissue around the joint.

2. How to increase knee flexion?
To improve your knee flexion, it is essential to engage in a structured rehabilitation program. Here are some strategies:
- Gentle Range of Motion Exercises: Start with passive range of motion exercises, where you or a therapist gently move your knee through its range without forcing it. Gradually progress to active range of motion exercises as tolerated.

- Stretching: Incorporate gentle stretching of the quadriceps, hamstrings, and calf muscles to improve flexibility.

- Strengthening Exercises: Once you can tolerate more movement, begin strengthening exercises for the quadriceps and hamstrings. This can include isometric exercises where you contract the muscles without moving the joint.

- Heat Therapy: Applying heat before exercises can help relax the muscles and improve flexibility.

- Physical Therapy: Working with a physical therapist can provide personalized guidance and ensure you are performing exercises correctly and safely.

3. Can I go to an external rehabilitation clinic?
Yes, attending a rehabilitation clinic can be beneficial. A physical therapist can assess your knee and develop a tailored rehabilitation program that focuses on improving your range of motion, strength, and overall function. Make sure to communicate your current limitations and pain levels to your therapist.

4. How long should I use crutches and the knee brace?
The duration for using crutches and a knee brace varies based on individual recovery and the surgeon's recommendations. Generally, crutches are used until you can bear weight comfortably on the affected leg without pain. The knee brace may be required for several weeks to months, depending on your healing progress and the stability of the knee. Follow your doctor's advice regarding when to transition away from these supports.

5. Will this affect future sports activities?
While it is natural to be concerned about the impact of your injury on future sports activities, many individuals can return to their pre-injury levels of activity with proper rehabilitation. However, the extent of recovery can depend on several factors, including the severity of the fracture, adherence to rehabilitation, and any complications that may arise during recovery. It is crucial to gradually reintroduce sports activities and listen to your body. Engaging in a comprehensive rehabilitation program will significantly enhance your chances of returning to sports without long-term issues.

In conclusion, focus on a structured rehabilitation plan, consider seeking professional help from a physical therapist, and maintain open communication with your healthcare provider regarding your progress and any concerns. With dedication and the right approach, you can work towards regaining full function in your knee and returning to your desired activities.

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