Patellar Fractures
A hard blow to the patella could result in a bone fracture, and due to the small size of the patella, it can be very difficult to repair. The standard methods of bone repair, open reduction and internal fixation—using wires and screws to put a bone back in place—is not easily performed on a bone that is roughly 2 to 3 inches in diameter. There is always a risk that if the surgical repair doesn’t work, it could actually cause more problems. The problems are secondary to the postoperative problems that are attendant to the immobilization required for fracture healing. The patient might have to be casted for upward of 6 weeks, which could result in stiffness. However, since the patella is such a critical part of the extensor mechanism, we try very hard to save it when we can. This is really dependent on whether the fracture is comminuted (in multiple pieces) or has one or two large pieces. In some cases we can’t save the patella, and it must be removed. After patella surgery, it is essential to get the joint moving again as soon as possible, because if it is immobile even for a short period, the joint will become stiff.
Osteochondritis Dessicans of the Patella or the Trochlea
Osteochondritis dessicans is a rare condition that primarily strikes children. For some unknown reason, the blood supply to a particular portion of bone is cut off, resulting in the death of the particular bone. The bone either falls off, which requires surgical reattachment or removal, or it may reattach itself and heal on its own. In the case of osteochondritis dessicans of the patella or trochlea, the articular cartilage on the surface of the patella or the trochlea can be disrupted, resulting in pain. Osteochondritis dessicans is diagnosed by X ray and the symptoms are pain and sometimes locking is possible if the piece of bone falls off.
Patellar-femoral Arthritis
Isolated patellar-femoral arthritis is a very rare condition. More often than not, arthritis will affect the entire joint, that is, the three compartments: the patellar-femoral, the medial femoral-tibial, and the lateral femoral-tibial. It will not stay confined to one compartment. In fact, according to one cadaver study, only 4 percent had isolated patellar-femoral arthritis, and women with kneecap malalignment were more prone to this problem. Patellar-femoral arthritis is difficult to treat. In cases of more generalized arthritis, if the disease becomes so severe that there is significant raw bone causing a great deal of pain, the physician may recommend a total knee replacement, which involves the resurfacing of all the bones of the knee joint with a prosthesis. However, if only the patella is arthritic, there are few options. Surgery involving only a patellar-femoral replacement—that is, the surgeon resurfaces only the patella and the trochlea of the femur—has not been that successful. In fact, there is less than a 50 percent chance that it will work as compared to a 95 percent success rate for a total knee replacement. However, because the arthritis has not affected other sites, physicians are reluctant to perform a total knee replacement, which in that situation would require the removal of healthy bone and articular cartilage. Usually, in the case of patellar-femoral arthritis, physicians will encourage their patients to undertake a serious strengthening program to see if that can relieve some of the pain. If the patient is over fifty-five, the exercise program is not working, and the patient is absolutely miserable, the physician may recommend a total knee replacement.
Rehabilitation Training for Patellar-Femoral-Type Syndrome
Similar to rehabilitation training for arthritis, the basic exercise plan for kneecap pain is to minimize weight-bearing stress while strengthening the surrounding muscles to assist normal patella tracking.
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