Rehabilitation

What happens as I recover?

The normal time course of fracture healing is measured in months. In the standard situation it takes 6 weeks for new bone formation to be detectable at the fracture site by x-ray. The strength of the healing fracture at this stage is about 50% of normal.

By three months there is good bridging bone across the fracture site and the margins of the fracture look blurred on x-ray as the gap between the fragments is filled in with new bone. The healing fracture has about 80% of normal strength by this stage. It actually take up to 18 months to consolidate the fracture and achieve 100% healing.

Of course, there are variation in this timetable depending on the nature and extent of the fracture. Avulsion fractures that have been fixed in position generally recover more quickly and fractures with a large number of fragments take longer. The surgeon, or the doctor following up the healing process will make decisions about weight bearing, exercise and return to heavier activity based on symptoms, X-ray appearance and the strength of the muscles.

As a general guide one might expect to be on crutches for six weeks putting no weight through the injured knee. Then, if the X-ray shows signs of healing, some partial weight-bearing can be permitted, still using crutches. If cast treatment is being used the cast is often changed at this time. A removable brace may be used instead of a cast. Full weight bearing and a vigorous rehabilitation program may be started at three months with return to work at four to six months depending on how heavy your work is.

It should be emphasized that this timetable is a general guide and may not apply to your individual case.

Most knee fractures require physical therapy to make a full recovery. Because the joint is injured and often has to be held still for a time you may require help getting it to move again through the full range. The period of immobilization and limited weight-bearing also results in wasting of the muscles so the next stage is recovery of strength.

The final stage in recovery of full function is occupational and sports rehabilitation so that you have the endurance to return to work and sports at your previous level. This may be a gradual process.

To a great extent the outcome of a knee fracture is determined at the moment of injury. If the fracture is a straightforward transverse fracture of the kneecap with minimal damage to the joint and a configuration which lends itself to anatomical reduction and secure fixation one can expect prolonged healing but eventual recovery to near normal and a good long term outlook. By contrast, if there is extensive damage to the joint surface, multiple fragments and an unstable situation the chances of a normal knee after recovery are much lower. The treatment and rehabilitation plan may affect the outcome - the intent being to give you the best possible chance - but the extent of the injury is the key factor in the end result.