There are a relatively low number of medium-long term outcome studies in patellar fractures. The overall picture is that function is modestly impaired but most individuals manage except in high load situations. Removal of metalware may be necessary.
Catalano et al,’Open Fractures of the Patella. Long-Term Functional Outcome’. The Journal of Trauma: Injury, Infection, and Critical Care: September 1995 – Volume 39 – Issue 3 – p 439-444.
79frax/76 pts. 80% incidence of multiple injuries. Average follow-up 21 months. All reconstructed, no primary patellectomy. 3 fixation failures, 1 nonunion. Average ROM 112º. HSS knee score at 36 months= good/excellent in 17/22.
Message: preserve patella at primary operation even if comminuted. Patellectomy reserved as a salvage procedure.
LeBrun, Langford, & Sagi, ‘Functional Outcomes After Operatively Treated Patella Fractures’. Journal of Orthopaedic Trauma: July 2012 – Volume 26 – Issue 7 – p 422-426.
241>110 sample after exclusions. 1.25-17 years follow-up, mean 6.5 years. Assessment: SF-36 & KOOS. Evaluation by physical examination assessing range of motion and Biodex bilateral quadriceps isometric and isokinetic comparisons.
Results: 52% required removal of symptomatic fixation material. 38% of remainder had metalware symptoms some of the time.
Eight patients (20%) had an extensor lag > 5°. A restricted range of flexion of > 5° was noted in 15 patients (38%) and restricted range of extension of > 5° was noted in 6 patients (15%).
‘Biodex dynamometric testing revealed a mean isometric extension deficit of 26% between the uninvolved and involved sides for peak torque. Extension power was also tested with an angular velocity of 90°/sec and 180°/sec and mean deficits of 31% and 29% were noted, respectively, when compared with the contralateral extremity’.
SF-36 physical composite score and KOOS were statistically poorer than reference population.
Vedel et al, ‘Altered long-term health-related quality of life in patients following patella fractures: a long-term follow-up study of 49 patients’. European Journal of Trauma and Emergency Surgery volume 44, pages707–716 (2018)
Cohort study, n=49, follow up 8.5 years. Assessment:EQ5D–5L, KOOS, muscle strength and gait analysis.
Results: radiological progression towards a higher degree of osteoarthritis of PFJ & TFJ; significantly lower knee extension strength in the injured leg compared to the non-injured leg (P = 0.011). No significant difference in gait speed and cadence compared to reference population. Knee osteoarthritis, muscle strength and gait patterns were not associated with HRQOL (R < 0.35). EQ5D–5L index value = 0.741, significantly worse than reference population.