1. On Your Knees
The patella is the kneecap. It is actually a tendon turned into a bone. The tendon of the front part of the thigh muscle, or quadriceps, attaches to the big bone of the lower leg, the tibia. The patella is a bone that rests within that tendon. The function of the kneecap is to protect the knee joint.
2. 3 Degrees of Separation
If the patella fractures completely through, its pieces often pull away from each other. When this happens, there will be a distance between them seen on an x-ray. A separation of the pieces by more than 3mm indicates surgery. The reason is that a separation greater than 3mm results in non-union, or bones not knitting together and points to future degenerative arthritis.
3. Know if It's Broken
Many times, kneecap fractures are not obvious. Clinically, they present as a kneecap that is still quite tender 5 to 7 days after an injury. There may be an accompanying degree of swelling and bruising. If you have an injury like this, you need to get it checked by your doctor. He or she will order a patellar series of x-rays to check for a fracture. These will include a sunrise view of the kneecap on-end that is useful in identifying fractures not seen on a typical knee x-ray.
4. More Than an X-ray
Sometimes a patient has negative x-rays, but continues to have pain. When this happens, your doctor uses other means of identifying fractures. These include bone scans, CT scans, and even MRIs. Confusing everything is the fact that the patella develops from 3 different parts that fuse together. In 1 to 2% of people, this fusion does not take place. This leaves a kneecap that has 2 or 3 parts. A bipartate patella can look just like one that is broken.
5. Surgical Options
If the patella requires surgery, there are three possibilities. The first is tension band wiring. In this procedure, the surgeon passes a wire around the patella in a figure eight configuration through both fracture fragments and then tightens the wire, drawing the fragments together. A modification of this procedure uses wires with cannulated screws. Sometimes, it may be necessary to remove a part of the knee cap and move the tendon down to cover the fracture site.
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