Non-Operative — Patella Fracture

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

100% WB with brace locked in full extension Phases I-II; full WB +/- brace Phase III (recommend brace unlocked in icy/crowded conditions); brace discontinued Phase III if walk without limp and SLR without wobbling

Key Restrictions

Hinged knee brace locked at 0 deg first 2 wks; stay within 0-30 deg ROM wks 2-4; avoid active knee extension and prone knee flexion Phase I; no sports until Phase IV (progress via graduated running/functional rehab program)

Timeline & Phases

Phase I (0-4 wks): brace locked at 0 deg first 2 wks, after wk 2 intermittent active/active-assisted flexion with passive extension 5-10 min QID and patellar mobilization, ROM stays 0-30 deg wks 2-4, isometric hamstrings (10-40 reps/set, 5 sets/day), avoid active knee extension and prone knee flexion, 100% WB with brace locked in full extension, EMG biofeedback to hamstrings only (no quads) if desired, cryotherapy, no sports; Phase II (4-6 wks): ROM 0-45 deg at wk5, 0-60 deg at wk6, advance to 0-90 deg as tolerated after wk6 (brace locked in full extension for ambulation only), initiate quadriceps strengthening and SLR, 100% WB with brace locked in full extension, no sports; Phase III (6-8 wks): ROM/brace use increase as tolerated, discontinue brace if able to walk without limp and maintain SLR without leg wobbling (otherwise keep brace on unlocked), progress hamstring/quadriceps strengthening exercises, stationary cycling as tolerated, full WB +/- brace (recommend unlocked brace in icy/crowded conditions), no sports; Phase IV (8-12+ wks): continue weaning brace if not yet done, ROM/strengthening as tolerated, modalities PRN, progress through graduated running/functional rehabilitation program, resume main sports once near-full ROM and >=80% quad/hamstring strength vs. contralateral side achieved (usually full sports by 3-4 months, with work conditioning progression if applicable)

Notes

OSMS Rehabilitation Guidelines; non-operative management of patella fracture; conservative timeline with explicit brace-discontinuation self-test (walk without limp + wobble-free straight leg raise)