Amy J. Litterini
© 2020 Elaina Cosentino
Background and Purpose: The patella serves an important role in the protection and biomechanics of the knee joint. A fracture of the patella typically requires surgery and immobilization, which can have detrimental impacts on functional mobility. The purpose of this case study was to document a rehabilitation program following a comminuted patella fracture status post open reduction internal fixation (ORIF).
Case Description: The patient was a 62-year-old female who sustained a comminuted patella fracture following a traumatic fall down the stairs, and underwent ORIF to her right patella. She was prescribed a straight knee immobilizer for eight weeks leaving her unable to take daily walks, play with her grandchildren, and drive. Physical therapy (PT) interventions, which began four weeks post-operatively, were chosen based on deficits in range of motion (ROM) and strength, quadriceps atrophy, knee extensor lag, and an antalgic gait pattern. The interventions included a lower extremity (LE) strengthening program, ROM, manual therapy, and gait training.
Outcomes: The patient demonstrated gains in right knee flexion active ROM (48 ̊ to 120 ̊) and passive ROM (46 ̊ to 125 ̊). Strength gains were demonstrated through manual muscle testing of knee flexion (4-/5; full ROM against gravity, mild resistance) and knee extension (4/5; moderate resistance). Treatment continued beyond the time of publication, but progress notes suggested improvements in strength and ROM, despite persistent functional deficits.
Discussion: The outcomes suggested a holistic LE strengthening program appeared to be successful in decreasing knee extensor lag, preparing the limb for ambulation without the immobilizer, and increasing functional mobility. Consistent with the literature, this patient had persistent functional deficits. Future research should focus on earlier PT intervention and effective approaches for increasing quadriceps muscle activity.
Cosentino, Elaina, "Restoring Functional Mobility For A Patient Following A Comminuted Patella Fracture Status Post Open Reduction Internal Fixation: A Case Report" (2020). Case Report Papers. 125.