Managing Patellar Fracture Recovery: Overcoming Muscle Atrophy and Stiffness

Patellar fracture

Hello, Doctor.
I had a car accident on January 1st, resulting in a comminuted fracture of my patella with approximately 6 to 7 fragments.
After surgery, my patella was stabilized with two steel pins and wires.
Initially, I was afraid of pain and did not engage in much exercise, which led to muscle atrophy.
Two months later, I could only bend my knee to about 30 degrees.
During my follow-up appointment, the doctor mentioned that there was adhesions, and he manually helped me bend it to 90 degrees.
Now, almost three months have passed, and due to muscle atrophy, I can only bend it to about 60 degrees, although with assistance, I can reach 90 degrees.
When bending further, I am afraid of pain and can only manage to bend it to 90 degrees.
What should I do? Is there a need for surgical intervention with anesthesia to forcibly bend it, or are there any less painful exercises that could help me improve my range of motion? Thank you for your response, Doctor.

Mr. Lin, 20~29 year old female. Ask Date: 2022/03/21

Dr. Shi Guozheng reply Orthopedics

Continuing rehabilitation therapy for patellofemoral pain should be done gradually.
When experiencing pain, it may be necessary to take anti-inflammatory pain relievers to facilitate the rehabilitation process.

Reply Date: 2022/03/21

More Info

Managing recovery from a patellar fracture, especially one that is comminuted (involving multiple fragments), can be quite challenging. The situation you described, where you have experienced significant muscle atrophy and stiffness, is not uncommon following such an injury and subsequent surgery. Here’s a comprehensive approach to managing your recovery, addressing muscle atrophy, stiffness, and overall rehabilitation.

Understanding the Injury and Recovery Process
A comminuted patellar fracture typically requires surgical intervention, as you have experienced with the placement of screws and wires to stabilize the bone. Post-surgery, the primary goals are to regain range of motion (ROM), restore muscle strength, and ensure proper healing of the fracture. The initial phase often involves immobilization and limited movement to allow the fracture to heal adequately.

Addressing Muscle Atrophy and Stiffness
1. Physical Therapy: Engaging with a physical therapist is crucial. They can provide a tailored rehabilitation program that focuses on gradually increasing your knee flexion and strengthening the quadriceps and surrounding muscles. They may employ techniques such as:
- Passive Range of Motion (PROM): Initially, your therapist may assist you in bending your knee to help regain flexibility without causing pain.

- Active Range of Motion (AROM): As you progress, you will be encouraged to actively move your knee through its range, which can help in reducing stiffness.

2. Strengthening Exercises: Once you have regained some range of motion, your therapist will introduce strengthening exercises. These may include:
- Quadriceps Sets: Tightening the quadriceps muscle while keeping the leg straight.

- Straight Leg Raises: Lying down and lifting your leg while keeping it straight, which helps strengthen the quadriceps without putting too much stress on the knee.

- Heel Slides: While sitting or lying down, sliding your heel towards your buttocks to promote knee flexion.

3. Pain Management: If pain is a significant barrier to movement, discuss pain management strategies with your healthcare provider. This may include:
- Ice Therapy: Applying ice to reduce swelling and pain.

- Non-Pharmacological Methods: Techniques such as TENS (Transcutaneous Electrical Nerve Stimulation) may help alleviate pain.

4. Gradual Increase in Activity: As you progress, gradually increase your activity level. Start with low-impact exercises such as swimming or cycling, which can help maintain cardiovascular fitness without putting excessive strain on your knee.

Surgical Intervention for Stiffness
If conservative measures do not yield satisfactory results, and if your knee remains significantly stiff (especially if you cannot achieve at least 90 degrees of flexion), a surgical procedure known as arthroscopic release may be considered. This procedure involves using a camera and small instruments to release any adhesions or scar tissue that may be limiting your range of motion. However, this decision should be made collaboratively with your orthopedic surgeon based on your specific situation.

Home Exercises and Self-Care
In addition to formal therapy, you can perform some exercises at home:
- Wall Slides: Standing with your back against a wall, slide down into a squat position and hold for a few seconds before sliding back up.

- Seated Knee Flexion: While sitting, try to slide your foot back under the chair to bend your knee as much as possible.

Monitoring Progress
Keep a journal of your progress, noting any changes in pain levels, range of motion, and strength. This can help you and your healthcare team adjust your rehabilitation plan as needed.

Conclusion
Recovery from a patellar fracture is a gradual process that requires patience and commitment. By actively participating in your rehabilitation, following your therapist's guidance, and addressing pain and stiffness proactively, you can significantly improve your outcomes. Always communicate openly with your healthcare providers about your concerns and progress, and do not hesitate to seek a second opinion if you feel uncertain about your treatment plan. Your goal of regaining full function and returning to your normal activities is achievable with the right approach and support.

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