Kneecap fracture - plating operation then rehab - any experience on timing ?

No advise but ouch! Healing vibes!!

I do not know anything about this particular injury.  However bones take around 4 weeks to knit together and around 8 weeks to get back to near their original strength 

Plating obviously holds a bone in the correct alighnment immediately but it weill not have anything like its full strength.

One of the quadriceps tendons run thru the kneecap indeed the kneecap can be considered a part of the tendon.  Thats a major part of straightening your leg.  If the break is across the kneecap then using your quads will tend to pull the break apart.

So i do not know enough to do more than guess at timescales but my guess would be a couple weeks before you can turn the pedals to keep the joint mobile and significantly longer before you can put any real effort in.

The more you work at rehab the quicker and better the outcome.  Diet supplements might be worth it.  Calcium and vit d come to mind.  Maybe zinc?

But as i say thats all just guessingbfrom a basic knowledge not anything specific

A mate of mine ended up with basically a shattered kneecap and double fractures in his shin a few years ago, initially told they might have to amputate above the knee but eventually had it plated together. His kneecap was in 5 or 6 pieces and he as off work around 8 months and off the bike around 10. Around a year later he had another op to remove the plates which led to another 3 months off the bike

Avoid Ibuprofen during bone healing process - wish I'd known my pelvis was extensively fractured rather than hobble on for six weeks on codeine and ibuprofen - consequently, stopped the ibuprofen when the NHS CT scanned me (after two xrays). I left the bike for three months as the 'sit' bone was fractured in two places (as well as the hip socket). 

Ask the surgeon about getting on a turbo. I suspect you'll need enough time for some bone healing before putting any stresses through it.

Can't help but sounds nasty, healing vibes. 

And I wish TJs 4-8 weeks was true for the fractured scaphoid I'm currently recovering from, 7weeks in and told yesterday that it'll be at least 2 more weeks before I can get on the road bike. 

Scafoids are notorious for crap healing.  

Broke mine into umpteen bits Nov 2015.

Had surgery which involved pins screws & wire. Surgeon told me he took the 9 big bits & stuck them together, then chucked the rest away.

I only had 4, 1/2 hour physio sessions and was left to my own devices.

I couldn't walk for 7 weeks and it was 5 months before I could ride again. Hopefully you will have better rehab than I did.

Nearly 10 years on it varies, I find riding in the winter it's more painful and I can't kneel without pain & it'll hurt the next day if I do. An older chap at the gym has had stem cell treatment to regrow cartilage & I will be looking at this myself soon.

Edit. Creatine helps with Atrophy during recovery.

Nothing to add, other than get well soon dude.

I am currently undergoing rehab from a knee surgery, not smashed kneecap but damaged cartilage under the patella and in a few different places. It involved nailing cartilage back on and performing a procedure called an AMIC. I was really lucky a very good friend is an ortho surgeon so put me in touch with an expert in my specific problem. I found there was quite mixed advice out there.

Having done a lot of research on this and I imagine your recovery will be quite similar because they wanted to stop my kneecap moving as it might damage the region underneath where as I imagine they want to keep yours immobile to let it heal. Being immobilized for so long led to big build of of scar tissue and muscle atrophy. 

First 3 weeks I was in a straight leg brace and non weight baring then I was allowed to try to bend to 40 degrees then after 2 weeks 70 degrees. Partial weight baring after the best part of a month then full weight baring another couple of weeks later. I say try to bend because I thought I would take the brace off and suddenly be able to bend it, Jesus.... it feels like someone has poured concrete into my knee and I am trying to bend through it. I am paying for a private physio weekly who is helping with increasing range of motion (basically bending my knee and making me cry) and keeping on top of exercises, adding new sets in as needed and generally keeping me on top of things. Knowing I am seeing someone weekly means I am not tempted to skip a day when I am tired etc

Having never used crutches before I didnt realize how many stairs I would encounter!

It's amazing how quickly your leg muscle goes, after about a week I started straight leg raises and quad tensing etc and was doing them 4 or 5 times a day. Before that I couldn't really lift my leg up without using my hands! I thought, not for me I am strong!

Depending on work, take as much time off as you can and treat your rehab as a full time job. Food, physio and recovery. 

I am just over 2 months out and am starting to walk to the few hundred yards to the shops and back, but it's very slow and I have a massive limp. I can bend to approximately 90 degrees and just yesterday I spent about 5 mins on the trainer spinning at about 20 watts! I am aiming to be able to get on the bike and do very very gentle rides by June. I have also just started driving in the last week. I am still spending at least 30 mins a day on exercise and on the weekend easily an hour.

Things to be aware of.... showering and going to the toilet is a nightmare. you will likely need something to put your leg up on when sitting on the toilet. For showering I got big plastic brace covers so I was able to keep it on when showering but it was over a week before I really thought of that and in the shower I got a suction handle to help stabilize me when on 1 leg.

I first knew I needed the surgery at the start of the year and it's been pretty intense so happy to share my experiences. 

This was me 2-3 weeks after

  I

Thanks all for the feedback  - alan very practical with bathroom advice with suction handles and waterproof cover for leg as this is already proving tricky. Length of rehab time probably relates to the success of surgery, hopefully the use of the newer locking plates may aid speed of return to motion but it'll be key to have good constant physio who understands whats need to get back to the bike. 

Hopefully it does not mean that I have to accelerate to an e bike .......

lets see how it goes tomorrow 

thanks 

Hope surgery today went well. Try not to overdo the cocodamol - the constipation is horrid.

Don't know about patellas, but have had 2 previous knee surgeries (ACLR and plate and pin tibial plateau fracture).

THey should (have) give(n) you some leaflets when you get discharged about what to expect. Physio will probably have visited you and made sure you are mobile on crutches. 

Re personal hygeine once i was mobileish I was wrapping the whole leg in clingfilm to get in the shower while i had dressings and stitches.

If you follow those instructions and take your cues on remobilisation from your orthopod and physio you should be good, but also listen to the knee and take your time initially and as you progress. Don't be tempted to overdo it too soon. You might look at a GameReady machine to speed recovery and reduce swelling and inflammation (but may be interesting with a patella injury?) https://www.gameready.co.uk/Rental.html

You should get some basic physio on the NHS, but as mentioned above, that will likely be until you are able to walk again, so any more specialist needs (running again, etc) you might need to push for that, or get your own physio.

Doing the kneehab exercises diligently is the key to a good outcome in the longer term, so don't let those slip. You probs need to be in a gym to fully address the quad wastage.

Cycling is good for kneehab and mobility and on both occassions was using the trainer with zero resistance to just turn the knee over after about 3 months (you can probs do some single the-other-leg routines to keep a semblance of cardio) and started with a light program with resistance again after 6 months. After the fracture i was back outside after 7 months, and climbing AdH after 12 (quite slowly) so no need for an eeb. I did ask on here somewhere if an eeb would help w rehab, but the consensus was that i would get more benefit with analog, and its cheaper) Cycling only won't build up the whole musculature around the knee so you eventually need to be doing rehab that incorporates sideways loading and impact if you want to do other sports.

Good luck with the recovery and rehab

Hope it's gone well. If you want fast recovery, I would pay for a private physio. 

I'm four months on from the fractured pelvis, and I've had zero interaction from the NHS physios (it's been requested apparently) - I've gone private to get fixed. I've actually more issues with my shoulder from three months on crutches, than I now have with my hip - it's healed really well and I can't tell I've broken the socket.

Speedy recovery !

Surgery went well but it was smaller pieces of bone so more surgical work and bone graft - almighty painful on waking so now on most pain meds mix and if I don’t move it’s ok. Kept in and see what the physios say tomorrow. Thanks filer messages as it does help lying here on the ward listening to other broken fellas snoring around me and wondering if there is anyway to get chocolate at this time of night ! 

happy Trails 

I inadvertently landed on a straight left leg - while on foot, not on the bike - off a metre-high bank the other day, which properly hurt my knee to the point that I needed crutches for a day or two and couldn't bend the leg or bear weight on it. Four days and a lot of icing and some ibuprofen and I'm pretty much getting over it bar the odd grumble, but it made me properly aware of just how painful and debilitating even a minor knee injury can be - in this case, according to my mate a sports physio, likely just minor internal shock trauma, causing a little bit of swelling, but enough to make the knee temporarily useless.

Which is a round about way of saying you have my sympathy and best wishes for a thorough and complete recovery. Oh, and do the rehab religiously, it sometimes gets boring, but as someone with a grumbly ankle made of limp spaghetti because I didn't know enough about rehab 30-odd years ago, I can tell you it's absolutely worth the effort.

Here's to you getting back on the trails as soon as possible 🙂 

Glad to hear it went well.

i imagine the pain will be worse today as all the strong meds wear off!

the fact you can walk is probably a good sign so hopefully the muscles will get a bit of work and not atrophy as much!

Home  now which is ace - doddering about 

Great news.

were they able to give you an idea of next steps?

2 weeks fully extended, 2 weeks 30 degree flexion, 2 weeks 60 degree flexion, 2 weeks 90 degree flexion controlled by a brace …

I had 10 days after surgery in a cast and then the brace with the same schedule as you, I was able to get to 30 almost immediately. Hopefully you will be able to do the same or better.

The brace will be much nicer than the cast. 

Hopefully the sleeping is going ok. I found the brace awful to try and get comfortable in, not as bad as a cast though!

try and pick a few box sets and settle in for a few weeks with your feet up!

doing ok sleeping now that I have convinced myself that its on my back or nothing. I'm now starting to wonder whether an E Bike would be something that would help with rehab .......or it might just be distraction theory ...

I managed after my first knee replacement without an ebike, just turbo with zero resistance at first to get it turning over, pedalling backwards was easier at first. Then slow amounts of resistance for short periods (like a few minutes) but a couple of times a day.  The hardest/dodgiest but was getting on and off the turbo using a crate.

Once outside it was a while before I could stand pedalling, and I made sure I really used the gears to spin.

I've done a couple of centuries since that knee replacement including long gravel rides...

However,  my other knee is waiting for one now (2.5 year list!) and I've given in with a tongsheng kit on my hard tail as often that one is too painful for much pressure on the pedals. Hopefully once that one's done I can go back to manpower atleast for tamer rides.

I'd assume as with a knee replacement the initial focus just needs to be getting a good/full range of motion back, before worrying a out strengthening.

Make your physio your job.

Once I was able I did a lot of work to strengthen my quad/patellae tendon.  Wall sits, slant board squats etc. but don't rush into that and speak to your surgeon/physio.

Good luck with it all!

thanks to alansd1980 - the leg condom and suction handle for getting showered have made me a new man this morning after my first sitting shower ! Common knowledge shared can be a real godsend in these situations  - owe you a beer if there was a virtual way to award people beers through the forum ! 

Glad the advice helped. 

I was pretty much a week out before my first shower so sounds like our trajectory is quite similar. 

maybe we can have a STW recovery ride for those of us who are crippled. 

10k of totally flat smooth gravel!

how is everything else going?

Just like most operations its stages but no pain no gain tends to be the mantra.

My son just had his ACL, MCL and meniscus done

My advice would be buy your own good crutches. We got some Flexyfoot Comfy Grip Open Cuff Crutches 

The other we got is a Cryo cuff. Helps with swelling and pain relief. Also will be useful in the future (won’t be able to use if in a brace)

Some great advice in here. Whilst I don’t have a smashed knee cap, I did manage to break my leg just below the knee.

had it plated earlier today and typing this from a hospital bed.

gutted doesn’t cover it, but such is life. I speak to the specialist tomorrow about the surgery and if any of the soft tissue and tendons are damaged (I am praying not).

physio sounds like the key to recover, so I will start looking at private assistance with that.

most painful part…. The blood thinners injections into my tummy! Ouch!!!

Will get some of those crutches on order too, look far more comfy than the NHS provided ones.

If it’s any inspiration for you guys that are laid up I managed 15mins on the trainer today with a average power of 50watts!

fair enough, a big drop from this time last year when my ftp was just under 300w but it’s definite progress from a couple of months ago when I struggled to wash myself!

The NHS crutches are OK - but I spent three months on them with a fractured pelvis and hip, and due to me relying on them, still in work, driving an automatic (left hip bust) etc, my right rotator cuff is now torn (or the physio recons). 

To offer folk some hope - badly fractured hip in January, but wasn't seen on x-ray. Went back in Feb and managed to get CT. Oh bugger. Avoided a total hip replacement as it was too late by the time it was found. Been told I'll need it doing one day.

Well, last weekend I did 3 1/2 hours on the CX bike, over half off road. No hip problems. Commuted on the bike the three days I was in work this week.

Physio has been checking progress with force plates - I do five squats and he measures leg force. It was 17% less six weeks ago - i.e. left leg 17% less strong than the right. That's down to 8% now.

Keep at it, and get moving.

The blood thinning injections are OK at the start (I got my wife to do them) but as time goes on you start to bruise. I had a couple of nasty ones, so gave up early as I was quite mobile (PS first 6 weeks didn't have any as we didn't know I had a break) Bit pointless TBH as probably could have died from a blood clot in those six weeks, but I wasn't that immobile as I was getting round on two crutches as I thought I'd just torn some ligaments.

Thanks for the info - will order crutches in finest ginger colour ! Re blood thinners they had me in the injections but on last hospital visit changed that to a pill called apixaban which is meant to do same thing without puncturing yourself. 

good job on the first goes on the trainer - seems a long way off and can imagine tricky to get on / off 

cheers 

When I was stuck with my leg up I found this series of videos on YouTube about an arsenal player called Hector Bellerin who did his ACL and he created a series of videos tracking his recovery. pretty interesting and nice to see the future mapped out a bit! Although  different injury the recovery looks similar

This is the first one

@gingerman69

hows it going? You are. Couple of weeks in now?

Now 3 weeks from attacking the wall and 2 weeks since patella ( kneecap) plating, pain is better and less pain killers which helps with a clearer head. Mobility in the full leg splint is a little easier and I can weight bear enough to stand on 2 legs at the kitchen counter to make brekfast etc which is 'freeing' ! Muscle bulk in the legs is going as not ebeing used though trying to do quad tightening exercies. First clilnic is friday this week so should know more then and hopefully share some post op xrays - getting back on the turbo is a long way ( may at 12 week mark ) off so have to put up with research and planning whether a gravel or full sus ebike may aid recovery ...

The progress in the first few weeks is slow, in fact it feels non existent but I am 3 months out and managed to ride the 7km round trip to work today for the first time. I couldn’t have imagined it even a month ago. Stick with the quad sets etc. I am seeing the benefit now.

It’s uphill all the way home so I am now shopping for an e bike! probably a hybrid or a hard tail for commuting so if you see any bargains let me know!

good luck Friday!

I fractured my kneecap in 2021

Fractured it in early Sept. Stupidly thought it was bruised and I needed to MTFU, carried on moving around for about 10 days (including a walking trip but had to resort to using walking poles!) until I realised I must have done something serious

Lucky to have private health insurance which really helped as the NHS support wasn't fantastic sadly. Didn't need surgery as the docs (I saw private and NHS ones in parallel) reckoned it wouldn't necessarily help and could create other problems down the line. Went to a private physio, took rehab pretty seriously

First proper ride was an easy bikepacking trip in early Jan. But probably a couple of months after that until I was back to being my normal fitness level. And maybe a little while after that before I could squat down fully!

@gingerman69

how the recovery going?

I fractured my kneecap in 2021

Fractured it in early Sept. Stupidly thought it was bruised and I needed to MTFU, carried on moving around for about 10 days (including a walking trip but had to resort to using walking poles!) until I realised I must have done something serious

I did Transwales 2006 with a fractured knee cap. I broke it a week before but thought I'd bruised the tendon. The NHS hot line asked a lot of questions and said that if I'd broken it I wouldn't be walking on it and it would hurt lots (what's lots to an MTBer ?) and I'd be on pain killers (I wasn't because I don't). So Transwales pedalling 90% with one leg and wondering what I was doing there. Back home the doc sent me for echo and X-rays. The echographer said the tendon's fine but there's a fracture through your patela -"look" - the view on the screen was very convincing, he called for a wheel chair that I declined on the basis that if it survived a week of MTB a bit more hobbling wouldn't make it worse. The hospital doc looked at the X-rays and told me I had remarkably strong muscles and tendons around the patela, and I was lucky, despite all the stupid things I'd done there was very little displacement on the fracture, critically less than a mm on the joint surface - no need to operate, it healed fine and apart from healing slightly bigger than the other one there have been no problems.

When the thread first appeared I didn't want to say anything that would influence our OP in any way as his break is cleary more serious than mine was. Other members have related more serious breaks more relevant to the case. Now six weeks on I hope that you are feeling a bit better, gingerman69 and won't mind a silly tale of woe on your thread. 

Thanks for all the stories and follow up - it does help  - sharing is caring ! Where I am now is 8 weeks in from crash and 7 weeks in from patella plating operation. The good news is the pain has mostly gone and I'm off the pills so feel like I have regained some mental clarity and able to move about more without concern of pain. I'm on crutches still but managing short distances in the kitchen with one and longer distances around local roads looking like a local hoody. The hinged brace is now unlocked to allow 60 degrees of flexion but I'm frustrated at only getting 30 degrees approx at present so will be discussing that with the physio this afternoon. Carrying on with quad exercises and flexing the knee vertically when on crutches will hopefully lead to better flexion.

Trying to work out a target for the turbo  - maybe 12 weeks but will discuss with physio as it will be flexion driven and think you need at least 60 degrees to spin ? A friend also mentioned that there are crank modifications that can help with this but hoepfully start without those.

@edukator  - glad its healing for you and funny that you did the trans wales as that was my adventure bikepack plan for this year - focus on next year. Still thinking that all these new ebike motors will mean people buy new bikes results in older ebikes coming up second hand suitable for rehab....

And on a slightly less positive note but realistic it seems that the incidence of patella fracture can increase chance of needing a replacment knee in the future, assume this is due to change in the surface of the patella abrading cartilage, arthritis etc but thats for another day ..

Time for some knee pads as well - whats the best ?

Yes, fractured my kneecap into 4 pieces, had it wired together and then another op to get wires out. I was amazed at how fast muscle tissue was lost from that leg. Mentally very hard to cope with being immobile and off the bike. It seemed recovery would take forever but you will get back to how you were. Although its a few years ago now, I am fitter then ever and have run marathons since. You must keep up with the physio plan they give you and get on the indoor trainer as soon as they allow. Cycling is a recommended therapy anyway. Sending over healing vibes!

I am 6 weeks into my tibial plateau fracture. Had a physio appointment this morning and have had the green light to remove the leg brace tomorrow and i can start doing exercises to start rebuilding. Managed to lose 10kg over the last 6 weeks... all from my right leg (well mostly).

Its so frustrating to see years of hard work waste away, but the good news is it should come back in half the time you took to build it in the first place. I followed all the NHS advice. No alcohol. Good food, good rest and despite the frustration to do more... being sensible. There is a lot to be said about listening to your body. If it hurts, stop, if it doesnt, crack on.

Positive vibes are a must. See the light at the end of the tunnel. Celebrate the small improvements and wins. Have a target or goal to aim for (for example, i am signed up to the Enduro2 in Meribel in August).

Good luck to you Gingerman.

Well done everyone for getting so far and sticking with the recovery.

i am 4 months from my knee op, different surgery but the recovery sounds the same, and live is slowly getting back to normal. This weekend I am stripping wallpaper after emptying the bedroom of furniture. A month ago that seemed like an impossibility!

I no longer worry about stairs and am now going up and down without the need for a handrail, general walking is fine and my daily steps is back up about 7 thousand.

I have been commuting on the bike to and from work for about a month, about 7km round trip and have joined a gym as it’s been recommended I do some swimming and use some of the leg machines to start building up muscle. I had been doing the at home sessions but it’s nice to do something different and get a change of scenery. 

Last week I took my MTB when my son was at his cycling club and even tried riding the course, got a bit scared on the tight turns and off camber sections so spent about 30 mins riding my own loop around the park it was a sunny evening and just amazing to be out. Knee is now very clicky but this seems to be normal.

Am looking at a short road or gravel event, around September time and then a winter of training before maybe trying to do something “normal” next year. 

From 6 weeks plus the improvements really do increase rapidly. I am taking collagen daily as well as turmeric extract and vitamin d. Who knows if it’s helping but following instructions feels like I am doing something!

@gingerman69 to get on the turbo I found I needed 90 degrees but even just using it to move through the bottom of the stroke was good for increasing the ROM and you will hopefully see 10-15 degrees increase per week. It is also useful to see how far round on the pedal stroke you can get, using the chain stair and down tube as points of reference.