3. ANATOMY - PATELLA
• Largest sesamoid bone
• Plays an important
role in the
biomechanics of the
knee.
• Very hard &
triangular-shaped
bone
4. ANATOMY - PATELLA
• Situated in an exposed position in
front of the knee joint
5. ANATOMY - PATELLA
• separated from the
skin by subcutaneous
bursa.
• Patella Surfaces
▫ Ant.
▫ Post
▫ Lat. & med.
6. ANATOMY - PATELLA
• Patella borders
▫ Base
▫ Med and Lat.
▫ Apex
• Articulation
7. ANATOMY - PATELLA
• Post. surface central portion, is
covered with a layer of hyaline
cartilage.
• Articular cartilage of the patella is the
thickest in the body (up to 7-mm
thick).
8. ANATOMY - PATELLA
• Improves the efficiency of extension
during the last 30° of knee extension.
9. PATELLA - FUNCTIONS
• guide for the quadriceps or patellar
tendon
• ↓ friction of the quadriceps mechanism
• Acts as a bony shield for the cartilage of
the femoral condyles
• Improves the aesthetic appearance of the
knee.
10. PATELLAR ALIGNMENT
• Influenced by the line of pull of the
quadriceps muscle group and by its
attachment to the tubial tubercle via the
patellar tendon.
• The result of these two forces is a
bowstring effect on the patella, causing
it to track laterally.
11. PATELLAR ALIGNMENT
• Q-angle is the
angle formed by
two intersecting
lines.
• A normal Q-angle,
women >men, is 10
to 15.
16. SIGNS AND SYMPTOMS of a
Possible Fracture
• Localized pain aggravated by movement
• Muscle guarding with passive movement
• Decreased function of the part
• Swelling, deformity, abnormal
movement
• Sharp, localized tenderness at the site
17. CLINICAL MANIFESTATIONS
• Pain in the
• Hemarthrosis
affected knee.
• Unable to
• Lacerations
perform a straight
leg raise
• Intra-articular
effusion
• Inability to extend
• Palpable defect at the knee against
gravity
the fracture site.
18. EPIDEMIOLOGY
• ~ 1% of all skeletal injuries.
• MC in people who are 20 to 50 years
old
• Men are twice as likely as women to
fracture the kneecap
19. ETIOLOGY
• Subcutaneous location of the patella
makes it prone to injury.
• Fractures occur as a result of a
compressive force such as a direct
blow, a sudden tensile force as
occurs with hyperflexion of the knee,
or from a combination of these.
20. ETIOLOGY
• A combination of these 2
mechanisms can lead to a variety
of other fracture patterns.
21. DIFFERENTIAL DIAGNOSIS
• Knee dislocations
• Fx of femur
• Fx of fibula and tibia
• Knee soft tissue injury
• Osgood-Schlatter Disease
• Trauma/PVI
• Sinding-Larsen Johansson
• Bipartite Patella
24. TREATMENT: NON-SURGICAL
• Controlled Motion
and Return to
Function Phases
▫ Educate the Patient
▫ Increase Flexibility
of Restricting
Tissues
▫ NWB(Open-Chain)
Exercises
▫ WB(Closed-Chain)
Exercises
▫ Functional
Activities
25. TREATMENT: SURGICAL
• Timing of surgery
▫ If the skin around your fracture has not
been broken may recommend waiting
until any abrasions have healed before
having surgery.
▫ Open fractures, however, expose the
fracture site to the environment
urgently need to be cleansed and require
immediate surgery.
26. INTERNAL FIXATION
•A Surgical procedure that:
▫ allows shorter hospital stays
▫ enables individuals to return to
function earlier
▫ reduces the incidence of
nonunion and malunion.
29. • External Fixators
• Other Considerations
▫ Surgical techniques reduce, but do
not remove, the risk of infection
when internal fixation is used.
▫ The severity of the Fx, its location,
and the medical status of the patient
must all be considered.
▫ No technique is foolproof
32. Prognosis
• It depends primarily on the quality of
articular restoration.
• Any intra-articular incongruities lead
to posttraumatic arthritis.
• Depends on the amount of chondral
damage sustained at the time of
injury.
33. Prognosis
• Some of these changes are irreversible.
• Functional outcome depends on the
ability to achieve early, pain-free, stable
range of motion.
• If arthrofibrosis develops, it may
require manipulation with the patient
under anesthesia or arthroscopic release
of adhesions.
34. EBP
• WHAT IS YOUR POSTOPERATIVE
MANAGEMENT OF PATELLAR
FRACTURES? Lang, Gerald J, MD. Thorofare:
SLACK INCORPORATED, 2008.
35. • immediately weight bear as tolerated
with the aid of crutches or walker.
This should be done with the knee in
a fully extended position.
• recommend static extension splinting
of the knee (with either a knee
immobilizer or hinged knee brace
that is locked in extension) while
weight bearing.
36. • .Active, active-assisted, and gravityassisted flexion can be initiated while
sitting on the edge of a table using the
uninjured leg to assist in supporting the
leg.
• Heel slides in a supine position can be
done as well.
• Isometric strengthening of the extensor
mechanism can commence as soon as
comfort allows.
37. • With the knee fully extended, the patient
can maximally contract the quadriceps
muscles and attempt a straight leg raise
• Active extension against gravity can also
begin in the early postoperative period.
• not recommended resistive exercises in
extension until the extensor mechanism
has healed (6 to 12 weeks).
• Passive ROM to obtain flexion is generally
delayed until the fracture and soft-tissue
repair are healed.
38. • Physiological and
methodological considerations
for the use of neuromuscular
electrical stimulation
• by: Nicola A. Maffiuletti; Accepted: 30 April 2010 /
Published online: 15 May 2010
39. • main aim of this review is to discuss some
evidence-based physiological and
methodological considerations for optimal
use of neuromuscular electrical
stimulation (NMES) in healthy and
impaired skeletal muscles.
40. • suggestion that NMES effectiveness would
not depend on external controllable
factors (e.g., current or electrode
characteristics), but rather on some
intrinsic anatomical properties, such as
individual motor nerve branching,
which determines the response of the
muscle to the application of electrical
current over the skin.
41. • it is strongly recommended to use
biphasic rectangular pulses of 100–
400 ls delivered at a stimulation
frequency of 50–100 Hz and at the
highest tolerated current intensity &
to apply NMES in a static loading
condition
42. • There are several lines of evidence
indicating that the higher the NMES
training intensity, the higher the
effectiveness of NMES (re)training, for
both healthy and impaired muscles.
43. • It is also recommended to stimulate the
muscle under resting conditions in order to
facilitate the quantification of pure NMES
evoked force.
• frail or current-sensitive subjects could be
asked to voluntarily contract their muscle
during the first few evoked contractions of a
session and/or during the first
• training sessions of a program so as to
decrease the sensation of discomfort
associated with NMES.
