Q: I am 29 years old house wife. I fell down at home and fractured my left leg patella. We shifted to India and got it operated there. After the operation, doctor said that due to the type of fracture it was not possible to join the patella and he had removed smaller lower segment of the patella. Now my plaster has been removed and I have started physiotherapy. I feel tightness in the thigh muscles and I am not able to bend my leg even a little bit, when physiotherapist bends it little, it pains. My Questions are: What type of exercises, treatment I should take for faster recovery? How much time will it take to bend my leg and start walking? What would be my limitations in the future with respect to normal working and what other knee problems could arise due to my partial patellectomy? What are the precautions to be taken to prevent future problems? We have an 11 months old son, so its very difficult to manage things. Please advise?

A:You have a very good chance of complete recovery. Well, I can give you a summary of what needs to be done, but each case needs to be dealt as per the individual’s clinical assessment. 1. a) Get your knee properly assessed for strength, endurance and ROM, and functional status done. Keep a record of weekly assessment. (b) Keep your limb elevated at regular intervals. (c) Isometerics to quadriceps should be done within painless range. If it is too painful, you can use TENS along with exercises to reduce pain. Gradually increase the number of repetitions. Keep your ankle dorsi-flexed when you do quadriceps contractions. The strength of your quadriceps is diminished by 25%-30% after surgery. Keep your normal leg bent at 45° to avoid strain on the spine. (d) If the knee is very stiff, which your therapist will be able to guide you, you can use CPM machine to bend your knee, and also ultrasound to relieve the pain. (e) Relaxed knee movements (swinging) can be started. (f) You should also do strengthening exercises for the hip, knee (quadriceps as well as hamstring) and ankle to strengthen your full leg so that you can walk well. (g) Active SLR is a must before you can get on to weight bearing exercises. You should do assisted and active-assisted exercises for bending your knee. Lastly, get on to resisted exercises. Ask your therapist to teach you VMO strengthening exercise. (h) When you get about 45° of knee bending, start with weight bearing exercises. (i) You may require slow sustained stretching of the knee with small weights. (j) See to it that the extensor lag (inability to extend the knee fully) does not remain. (k) Single leg standing, weight transfers and correct knee sequence in gait training should be learnt. 2. It usually takes about 4-6 weeks to achieve knee bending and quadriceps strength. Your X-ray will be the guide to allow you to walk. Usually after 6 weeks, your surgeon may allow you to walk without support. You should be fine by the end of 12 weeks. 3. I don’t think you should have any limitation with respect to normal walking. 4. I don’t think you should worry about any future problems. Keep a check if your knee is not bending properly and if you continue to have excruciating pain in the front of your knee and inform your doctor. 5. Precautions you need to take are: (a) Do not add on any extra weight. (b) Wear sensible shoes. Avoid high heels. (c) Avoid standing for long duration of time. (d) Be careful while descending stairs. The compressive load across the joint is 5 times the weight of the body while descending stairs. This may accelerate degenerative changes in your joint. (e) Do not rush to start driving till your knee strength is on par with the other leg. This can take a few months.