Patella Fracture Treatment
A patella fracture is a break in the kneecap — the small, triangular bone that sits at the front of the knee and serves as the mechanical connection between the quadriceps muscles and the shinbone. The kneecap’s primary role is to improve the leverage of the leg’s extensor mechanism, giving the quadriceps the ability to straighten the knee with enough power for walking, running, jumping, and climbing stairs. When the patella fractures — typically from a direct fall onto the knee, a dashboard impact, or a forceful blow during contact sports — the knee’s extensor mechanism can be disrupted, producing immediate pain and impact knee function to the point where straightening the leg or bearing weight becomes difficult or impossible. Because the quadriceps and patellar tendons attach directly to the top and bottom of the kneecap, the pulling forces of these muscles can separate the fracture fragments, making surgical repair necessary in many cases.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, widely recognized as one of New York City’s top knee specialists. His published research on patellar viability and the contribution of the infrapatellar fat pad to the knee’s extensor mechanism gives him a uniquely informed understanding of the anatomy and biomechanics involved in patella fractures — knowledge that directly impacts surgical planning and rehabilitation decisions. With over 30 years of experience, more than 15,000 procedures performed, and roles as Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers, Dr. Glashow treats kneecap fractures at every level of severity — from stable cracks that heal with immobilization to complex comminuted fractures requiring surgical reconstruction of the extensor mechanism. Named a Castle Connolly Top Doctor every year since 2000, he offers same-day X-rays, immediate evaluation, and emergency surgical capability for patella fractures at his Upper East Side practice in New York City.
Causes and Symptoms of a Kneecap Fracture
The patella is a thin bone that can be broken or shattered. The most common cause of a patella fracture is a direct blow to the front of the knee. Auto/motorcycle accidents, falls and contact sports are typical activities that can result in a broken kneecap. There can be single or multiple fractures in the bone, resulting in the following symptoms:
- Pain and tenderness around the kneecap
- Swelling of the knee
- Disfigurement of the knee
- Knee pain when bending or extending the leg
- Difficulty extending the leg
A minor fracture may heal on its own with treatment to hold the bone in place. However, patella fracture treatment may require surgery if the bone is cracked or broken into two or more pieces. Surgery can include repairing the patella by using surgical hardware to secure the pieces of bone together. In severe patella fractures, shattered pieces of the bone may need to be removed if they cannot be repaired.
If you sustain a direct blow to the knee and have symptoms of a fractured patella, contact our team at Jonathan Glashow, MD, Orthopedic Surgery & Sports Medicine for a consultation with one of our orthopedic specialists. We offer same day appointments and treatment for fractured kneecaps at our facility in New York City.
Frequently Asked Questions About Patella Fractures
How do I know if my kneecap is fractured or just bruised?
A fractured kneecap and a severe bruise can both cause significant pain, swelling, and difficulty bending the knee. The distinguishing signs of a fracture include an inability to straighten the leg or perform a straight leg raise (because the extensor mechanism is disrupted), a palpable gap or depression in the front of the kneecap, visible deformity, and rapid onset of swelling within the first few hours. Because some non-displaced fractures are difficult to distinguish from soft tissue injuries without imaging, Dr. Glashow recommends X-rays for any significant impact to the front of the knee that produces these symptoms.
What happens if a patella fracture is not treated?
An untreated displaced patella fracture can result in the bone healing in a misaligned position (malunion), which alters the mechanics of the knee’s extensor mechanism and leads to chronic anterior knee pain, quadriceps weakness, difficulty walking, and accelerated wear of the cartilage on the underside of the kneecap. In some cases, the fracture may fail to heal entirely (nonunion), leaving the extensor mechanism functionally disrupted. Prompt evaluation and appropriate treatment — whether conservative or surgical — are essential for restoring normal kneecap function and preventing long-term complications.
Do all patella fractures require surgery?
No. Stable, non-displaced fractures — where the bone pieces remain in proper alignment and the patient can still actively straighten the knee — can often be treated with a knee immobilizer or cast for four to six weeks, followed by physical therapy to restore range of motion and quadriceps strength. However, because the quadriceps tendon pulls on the top of the kneecap during any attempt to straighten the leg, most displaced fractures require surgical fixation to hold the fragments together against this pulling force. Dr. Glashow evaluates each fracture with X-rays and clinical testing to determine the best approach.
What does patella fracture surgery involve?
The specific technique depends on the fracture pattern. Dr. Glashow most commonly uses open reduction and internal fixation — realigning the fragments and securing them with wires, pins, screws, or a combination of hardware. For two-part fractures, a tension band wiring technique converts the quadriceps pulling force into a compressive force that promotes healing. For comminuted (shattered) fractures, a combination of cerclage wires and screws may be used. In severe cases where the bone cannot be reconstructed, partial removal of the damaged kneecap with reattachment of the tendon may be necessary. Surgery is performed at Midtown Surgery Center on an outpatient basis.
How important is physical therapy after a patella fracture?
Physical therapy is critical for recovering full knee function after a patella fracture — and it is arguably more important for this injury than for almost any other knee condition. The knee is highly susceptible to stiffness after any period of immobilization, and the quadriceps muscle weakens rapidly when the extensor mechanism is disrupted. A structured rehabilitation program that progresses through range-of-motion recovery, quadriceps activation, progressive strengthening, and functional training is essential for regaining the ability to fully straighten and bend the knee, walk normally, and return to physical activity. Dr. Glashow coordinates rehabilitation closely with physical therapists and monitors each patient’s progress with follow-up imaging.
Can I return to sports after a patella fracture?
Most patients are able to return to full activity after a patella fracture, though the timeline depends on the severity of the fracture, whether surgery was required, and the individual’s healing and rehabilitation progress. Non-surgical fractures typically allow a return to light activity within two to three months. Surgical cases generally require four to six months before returning to impact sports or activities that load the extensor mechanism heavily. Dr. Glashow uses objective strength testing and range-of-motion assessment — not just a calendar timeline — to determine when each patient is ready to return safely.
