Patella stress fracturesPatella stress fractures are rare but essential injuries to recognise, particularly in athletes and physically active individuals. They are often confused with other causes of anterior knee pain, such as patellofemoral pain, knee arthritis, and tendonitis. So, how do you diagnose and manage a patella stress fracture?
What is a Patella Stress Fracture?
A stress fracture occurs when excessive loading exceeds the bone’s capacity to repair itself, leading to microdamage, bone swelling, and fracture. In the patella, these injuries are often linked to activities involving repetitive jumping, running, or sudden increases in physical activity. Patellar stress fractures can occur in isolation or in combination with other knee injuries, such as arthritis and tendonitis.
How to Diagnose a Stress Fracture of the Patella
Stress fractures of the patella are exceedingly rare. However, particular sportspeople, such as footballers, basketball players, and runners, are more at risk. These sports place high force on the patella and patellofemoral joint.
Generally, a patella stress fracture presents with the following symptoms:
- Anterior knee pain that worsens with activity, particularly running, jumping, or climbing stairs. Sometimes, pain can occur acutely after a significant jump or pivot.
- Localised tenderness over the patella.
- Swelling of the patella or knee joint.
- A history of increased or altered training load or trauma to the kneecap
When your doctor examines you, she may find tenderness of the patella and pain with weight-bearing activity. Sometimes, the knee may be swollen.
Other causes of pain at the front of the knee that need to be excluded include patellofemoral pain, patellar or quadriceps tendonitis, kneecap arthritis, and Osgood Sclatter’s disease.
Investigations
Generally, X-rays may reveal a visible fracture line across or up and down the patella. However, early stress fractures may not be visible on X-rays. So, a normal X-ray does not exclude a stress fracture.
MRI is the gold standard for diagnosing stress fractures. It can detect early bone marrow oedema and microfractures before they appear on X-rays. MRI is also helpful in excluding other conditions, such as kneecap arthritis and knee tendonitis. In some cases, bone health investigations, such as blood tests, including vitamin D levels and bone density scans, are needed.
Management
Generally, we start with conservative management consisting of the following:
- Activity Modification: We advise ceasing activities that exacerbate symptoms, such as running and team sports, and adopting low-impact exercise, such as swimming or cycling. As the fracture heals, we allow progression into running and a change of direction.
- Immobilisation: In severe cases, a hinged knee brace may offload the patella and facilitate healing for 4-6 weeks.
- Physical Therapy: We focus on restoring range of motion, strengthening the quadriceps and surrounding muscles, and gradually returning to activity.
- Bone health: To support bone healing, ensure adequate intake of calcium and vitamin D. Sometimes, treatment such as LIPUS (low-pulsed ultrasound) can improve bone healing.
We consider surgical treatment if conservative treatment fails or a fracture is displaced. Surgery often involves using wires across the patella to fix the fracture.
Final Word from Sportdoctorlondon about Stress Fracture of Patella
While uncommon, a patella stress fracture requires a high index of suspicion, particularly in athletes with knee pain. Early diagnosis through imaging is crucial to ensure optimal outcomes. Most cases respond well to conservative management, but surgical intervention may be necessary for displaced or persistent pain. If you’re experiencing persistent knee pain, consult a sports medicine professional for an early diagnosis and management plan.
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