Can You Walk With A Fractured Kneecap? | An Explanation From Our Physical Therapist

You know the patella is a vital bone of your knee. That said, can you walk with a fractured kneecap? Or will it worsen the fracture?

The answer depends mostly on the type of fracture.

For example, a non-displaced fracture will still have bone pieces in their original position. In this case, your doctor may consider it safe for you to walk with a knee brace if you can do a straight-leg raise.

But, in displaced patellar fractures, the broken pieces are out of place. This means the bone isn’t aligned anymore and walking can worsen the alignment. So, walking isn’t recommended, if at all possible.

In any case, you can find guidelines about the following below:

• When to walk with a patella fracture, and when not to.
• If you can, how to do it.
• Other things to help your healing process.

Can you walk with a broken kneecap?

Avoid walking with a patella fracture if…

The x-ray shows it’s displaced and/or comminute. Also, avoid walking with an open fracture.

Even though these are case-by-case evaluations, weight-bearing can worsen the misalignment. For comminute fractures, walking may damage the surrounding tissue as well.

Patients will probably need some kind of surgical repair before walking again. Your doctor may also recommend a cast or some type of brace before surgery.

It may be safe to walk with a fractured kneecap if…

• The x-rays show the fracture is non-displaced.
• You can perform a straight leg raise – this means the tissues around your kneecap are okay.
• You have mild pain.
• Your doctor considers it’s safe.
• You’re going to physical therapy.
• You’re wearing a knee brace.
• You won’t put your full weight on the injured leg unless your therapist or doctor allows you to.

How to walk with a patella fracture?

Your physical therapist will give you individual recommendations about:

• Walking with a fractured kneecap, and
• For how long

Along with other instructions, it’s imperative that you follow your PT’s directions. After all, they’re there to make sure your bones heal properly.

Here are a few more guidelines about how to walk with a fractured kneecap:

• Avoid climbing or going downstairs.
• Avoid sudden movements.
• Don’t push through the pain.
• Don’t remove your knee brace unless your therapist or doctor allows you to.

P.S.: We can help you find a physical therapist!

How do you know if you have a patella fracture?

The patella – also called “kneecap”- is the bone at the front of the knee. It looks like an inverted triangle.

Two important tendons attach to it:

• The quadriceps tendon at the top. It covers the kneecap and connects the thigh muscles to the lower leg.
• The patellar tendon, at the bottom.

What does the patella do?

It glides up and down the groove of the thigh bone -called “femur”- every time we move our knees. This means the kneecap moves with every step we take.

Plus, our kneecap has a thick cartilage on its posterior surface. It’s the thickest cartilage we have in our bodies. And, it helps make the kneecap gliding as smooth as possible. (1)

The patella has a few responsibilities:

• Protect the front of the knee joint.
• Work as a fulcrum that makes our quadriceps more efficient.
• Absorb and distribute the impact coming from the lower leg when we walk, jump, run, etc.

Symptoms of a broken kneecap

A fractured kneecap happens when the bone cracks or breaks. Some symptoms include (2):

• The front of the knee may look bruised and swollen.
• Intense knee pain while standing or walking.
• In displaced fractures, there will be a palpable deformity on the bone.
• You may or may not be able to do a straight-leg raise.
• Tingling or numbness on the foot of the injured side.

An X-ray will confirm the presence of a broken kneecap.

Causes of a broken patella

Patella fractures account for 1% of all fractures. They occur mostly in people between 20-50 years old and are more common in men. (1, 2)

There are two common causes of kneecap fractures:

Direct impact

Like a fall directly onto the knee, or a direct impact with the dashboard during a car accident.

Motorcycle accidents can also result in patella fractures.

Indirect impact

These happen because of sudden and/or excessive quadriceps contractions.

For example, when you fall on your feet with your knees straight, the impact may force your knee joint to bend. This sudden knee flexion will force a strong stretch on the quadriceps tendon. This, in turn, can pull the patella to the point of breaking. (2)

We can classify the severity of the fracture according to the degree of separation of the fragments:

Types of patellar fractures

Non-displaced

The pieces of bone are still in line with each other and/or the separation is less than 3mm. The bones usually stay in place while healing. (3)

The treatment is non-surgical unless the pieces move out of place.

If there are 3 or more shattered parts, we call it a “comminute fracture.” More than 50% of these are non-displaced. But, there’s usually significant damage to the surrounding tissues. (3)

If severe, it will need surgery. (2)

Displaced

The bone fragments are not aligned with each other and/or the separation is more than 4mm. Most cases need surgery to align the pieces. (3)

Depending on the cause, the fragments may break the skin and expose the bone. This is called an “open fracture”.

It’s a severe injury that requires immediate surgery and has a high risk of infection if not treated soon.

Treatment for a fractured kneecap

Non-surgical treatment for a patella fracture

This is the best option if the fracture is non-displaced and you can perform a straight leg raise.

You’ll have to wear a splint for the first few days. And, in the following weeks, while the bone heals, a knee brace or crutches may be necessary. (3)

You’ll also work with a physical therapist. Your PT will help you move without displacing the bone fragments.

That said, prolonged immobilization can cause nonunion of your bone fragments. So, it’s imperative that you regain your range of motion as soon as possible.(2)

Also, your doctor will need to re-check if the bone ends are still in place. They will usually schedule an x-ray after the first week of physical therapy.(1)

“It is assumed that 8 to 12 weeks are necessary to achieve bony healing of a fracture of the patella.” –Gwinner, 2016

Surgical treatment for a broken kneecap

You will need surgery if (3):

• You have a displaced fracture.
• There are many pieces of bone fragments.
• The fracture tore the quadriceps tendon.
• It’s an open fracture – here, surgery is immediate.

Surgery can be scheduled after a few days if the fracture is not severe or if there’s a lot of swelling. Your doctor may recommend some pain medication and a cast while waiting for the day of surgery.

The goal of surgery is to reconstruct the kneecap to allow movement as soon as possible. (4)

After surgery, it’s best to do physical therapy as early as possible. (3, 4) This will help you get back to full weight-bearing and recover knee joint mobility.

Early physical therapy helps prevent joint stiffness. A lot of time, this helps avoid the need for revision surgery. (3, 4)

Your recovery will depend on the following(3) :

• Severity of the fracture,
• Type of surgery, and
• How compliant are you with the treatment.

Recovery can take at least 8 weeks. But, open fractures and non-compliant patients will need more time. (3)

FAQs

Conclusion: Can you still walk with a fractured patella?

Your physician is the best person to answer this question, but in general:

• Probably yes, if it’s non-displaced and you can perform a straight leg raise. Walk with some modifications to let the kneecap heal properly. Your therapist will teach you how.
• Probably no, if it’s open, comminute, or displaced.

Whichever the treatment, make sure to follow the instructions to the T – you’ll make sure it heals fully and without complications!

Resources

1. Luo, David, et al. “Patella Fractures.” [Updated 2021 Feb 2]. StatPearls. Retrieved on June 26, 2021 from: https://www.ncbi.nlm.nih.gov/books/NBK513330/
2. Gwinner, Clemens et al. “Current concepts review: Fractures of the patella.” GMS Interdisciplinary plastic and reconstructive surgery DGPW vol. 5 Doc01. 18 Jan. 2016, doi:10.3205/iprs000080
3. Melvin, J Stuart, and Samir Mehta. “Patellar fractures in adults.” The Journal of the American Academy of Orthopaedic Surgeons vol. 19,4 (2011): 198-207. doi:10.5435/00124635-201104000-00004
4. Steinmetz, Sylvain et al. “Practical guidelines for the treatment of patellar fractures in adults.” Swiss medical weekly vol. 150 w20165. 15 Jan. 2020, doi:10.4414/smw.2020.20165