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The patella, or kneecap, is the small, floating, sesamoid bone that is located at the front of the knee. The patella is one of three bones, along with the tibia (shin bone) and femur (thigh bone), that make up the knee joint. The patella is embedded inside the quadriceps tendon which connects the quadriceps muscle of the thigh to the shin bone (tibia) below the knee joint. The patella acts as a pulley for the quadriceps and helps create more power during movements of the knee.
A patellectomy is required for a number of reasons including severe osteoarthritis of the knee, anterior knee pain or a comminuted (shattered) fracture of the patella.
During a patellectomy, an incision is made into the quadriceps tendon and the patella is freed and removed. With this procedure, the patella tendon remains intact and partially functional. However, the removal of the patella can cause a number of functional problems including;
- Extension lag : the reduction in ability to straighten the leg fully
- Increased laxity: the loss of the patella leaves the quadriceps tendon lax, and the knee prone to dislocation
- Vulnerable femoral joint surface: without the protection of the bony patella, the important cartilage covering the end of the femur is easily damaged by knocks and falls
- Knee replacement limitations: knee replacement is problematic after patellectomy. The relatively recent development of 'resurfacing' procedures offers some hope for relief of instability (replacement of the trochlea with an artificial metal surface).
Physiotherapy before patellectomy
Physio.co.uk recommends physiotherapy prior to your patellectomy to better prepare your knee for surgery and strengthen the muscles around your knee for essential support. Physiotherapy with Physio.co.uk before your surgery will focus on strengthening your quadriceps muscle as much as possible to reduce the likelihood of decreased range of movement once your patella has been removed. Your physiotherapy will also include strengthening the muscles in your hip, ankle and opposite leg to ensure your knee has as much support as possible after your surgery.
Symptoms after patellectomy
Once your patella has been removed you will suffer from instability in your knee joint along with pain and swelling. You will also experience stiffness and a significant reduction in range of movement in your knee and may be unable to straighten your leg fully. You will be given crutches for up to 2 months after your surgery and will also be required to use a knee brace or immobiliser during this time to protect and support your knee. You will be unable to drive until you have full, painless range of movement in your knee.
Physiotherapy after patellectomy
A comprehensive physiotherapy programme is crucial after undergoing a patellectomy.
Early stage (0-4 weeks)
The main aims of a physiotherapy programme with Physio.co.uk in the initial weeks after your patellectomy surgery will be to maintain mobility, reduce any pain and swelling, increase stability, improve range of movement and strengthen the muscles in and around your knee. You will be non weight bearing with crutches and using knee immobiliser at this stage. You should carry out physiotherapy as often as possible after your patellectomy. Your physiotherapy will include:
- Cryotherapy (ice)
- Passive (assisted) range of movement exercises within limits of brace
- Non weight bearing exercises
- Ankle exercises
- Stretching and strengthening of quadriceps
- Stretching and strengthening of hamstrings
- Stretching and strengthening of calves
- Hip exercises
- Scar massage
- Hydrotherapy
Middle stages (4-8 weeks)
After your first month of physiotherapy post patellectomy, you physiotherapy programme with Physio.co.uk will focus on continuing strengthening and flexibility exercises from previous weeks for your quadriceps, hamstrings and calf muscles. Your physiotherapy will also aim to control any pain, stiffness and swelling you may be experiencing, whilst strengthening your hip, ankle and opposite leg for continued support. You will now be beginning to partially weight bearing and you will still be using a form of knee brace. At this stage, you will have progressed to exercises involving active (on your own) range of movement. Physio.co.uk also recommends hydrotherapy at this stage.
Later stages (8-12 weeks)
In the later stages of your recovery your physiotherapy programme with Physio.co.uk will now gear towards progression to full weight bearing whilst also focusing on functional exercises that are specific to your hobbies or everyday activities. Your physiotherapy will further include the continuation of stretching and strengthening of muscles around your knee, hip, ankle and opposite leg as well as begin to work on your cardiovascular fitness. Your physiotherapy will include:
- Active range of movement exercises
- Partial to full weight bearing activities
- Gait training once fully weight bearing
- Proprioception training (balance) one fully weight bearing
- Stretching and strengthening of quadriceps, hamstrings and calf muscles
- Hip and ankle exercises
- Functional specific activities
- Stationary bike (resistance as tolerated)
- Hydrotherapy
Summary
A patellectomy is the surgical removal of your patella (knee cap). The main purpose of undergoing a patellectomy is required to relieve symptoms if you are suffering from severe arthritis of your knee joint, debilitating anterior knee pain or a shattered patella as a result of trauma. After your patella have been removed you will experience considerable instability in your knee as well as a reduction in muscle strength, range of movement and muscle control whilst also leaving your knee joint unprotected. It is essential that you take part in a comprehensive physiotherapy programme with Physio.co.uk to regain stability and full or near full function in your knee whilst also getting your back to your everyday life as soon as is it physically possible. Call Physio.co.uk now on 0330 088 7800 for more information or to book an appointment. Alternatively you can book online or send us an email at office@manchesterphysio.co.uk.
