PATELLECTOMY

REHABILITATION
Khateeja tul kubra
3rd year BPT
CCOP, Mysore
CONTENT
01 DEFINITION

02 INDICATIONS

03 PROBLEM LIST

04 GOALS

05 REHABILITATION PROTOCOL

06 REFERENCE
 Introduction
The patella, commonly known as the kneecap,
is a small, flat, triangular bone located in front
of the knee joint. It plays a crucial role in the
biomechanics of the knee.
The patella is embedded within the tendon, which connects the
quadriceps muscles to the tibia. This arrangement allows the
quadriceps to exert force on the patella, which in turn helps to
extend the knee. And that is why it is called as anatomical pulley.
The patella moves within the trochlear groove of the femur as the
knee flexes and extends.
It serves as a protective cover for the knee joint, reducing friction
and providing a smooth surface for the movement of the knee.
During weight-bearing activities, the patella helps to distribute
forces evenly across the knee joint, reducing stress on the
underlying bones and cartilage.
 Biomechanics of patella
During knee extension, the quadriceps muscle contracts, and the
patella glides upward along the femoral groove. This movement
increases the lever arm of the quadriceps, improving the efficiency
of the muscle’s force to extend the knee.
During knee flexion, the patella moves downward along the
femoral groove, maintaining its alignment with the femur. This
allows the quadriceps muscles to effectively control knee flexion
and prevent lateral displacement of the patella.
The primary function of the patella is to increase the moment
arm of the extensor mechanism around the knee, improving
the efficiency of quadriceps contraction.
The moment arm of the quadriceps muscle is greater with a
patella than without a patella.
The patella improves the angle of pull of the quadriceps
muscle, enabling more efficient knee extension.
 Patellectomy
It is a surgical procedure where the patella is partially or
completely removed.

It is typically considered as a last resort treatment option for

certain knee conditions when other conservative treatments have
failed to provide relief.
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.

Partial Patellectomy- for smaller distal or proximal pole fracture.

Complete Patellectomy- For communited fractures.
Partial Patellectomy Complete Patellectomy
INDICATIONS
Patellar fractures
Advanced chondromalacia
Recurrent Dislocations
Osteoarthritis of knee
Patellar osteomyelitis
Rheumatoid arthritis
Patellar tumour
PROBLEM LIST

1. Swelling and inflammation around the knee joint.

2. Limited range of motion in the knee.
3. Weakness in the quadriceps muscles.
4. Difficulty in walking or bearing weight on the affected leg.
5. Instability and difficulty balancing.
6. Persistent pain and discomfort.
7. Scar tissue formation and adhesions.
8. Muscle atrophy in the affected leg.
9. Difficulty in bending and straightening the knee. (Extensor lag)
10. Reduced proprioception & coordination.
GOALS
1. Reduce swelling and inflammation.
2. Manage pain and discomfort.
3. Improve Range of motion.
4. Restore quadriceps strength.
5. Enhance WB ability.
6. Improve balance & stability.
7. Prevent scar tissue formation and adhesions.
8. Rebuild muscle mass & prevent atrophy.
9. Achieve full knee flexion & extension.
10. Enhance coordination & movement control.
11. Increase functional independence.
12. Return to sports & physical activity.
REHABILITATION PROTOCOL
Phase 1: Initial Postoperative Phase (Week 1-2)

1. Reduce Swelling and Inflammation:

• Focus on RICE protocol (Rest, Ice, Compression, Elevation)
& compression bandages to manage swelling.
• Begin gentle range of motion exercises to prevent stiffness.
Phase 2: Early Rehabilitation Phase (Week 2-6)

1.Gradual Weight-Bearing Progression: ( knee immobilizer is

mandatory)
• Gradually transition from non-weight-bearing to partial
weight-bearing using assistive devices.
• Start with assisted standing and walking exercises.
2. Improve Range of Motion and Flexibility:
• Continue with range of motion exercises, incorporating
passive stretching as tolerated.
• Utilize continuous passive motion (CPM) machines if
recommended.
KNEE IMMOBILIZER PASSIVE QUAD STRETCH
 3. Strengthening the Quadriceps:
• Begin isometric quadriceps contractions to initiate muscle
activation.
• Progress to active-assisted and active quadriceps strengthening
exercises.

4. Balance and Proprioception Training:

• Engage in static balance exercises (e.g., standing on one leg)
with support.
• Perform proprioception drills using balance boards or foam
pads.
SINGLE LEG STANCE

PROPRIOCEPTION DRILLS
Phase 3: Intermediate Rehabilitation Phase (Week 6-12)

1. Full Weight-Bearing and Gait Training:

• Transition to full weight-bearing activities as the knee
becomes more stable.
• Implement gait training to establish a more natural walking
pattern.
2. Advanced Quadriceps Strengthening:
• Incorporate resistance training exercises like leg presses and
squats.
• Focus on improving quadriceps endurance and strength.
SQUATS LEG PRESSES
LUNGES STEP- UPS
WALL SITS HIIT
3. Functional Activities:
• Introduce functional
exercises to simulate daily
tasks (e.g., stairs, sit-to-
stand).
• Emphasize proper form
and mechanics during
activities.
Phase 4: Advanced Rehabilitation Phase (Week 12 and beyond)

1. Full Range of Motion:

• Work towards achieving full knee flexion and extension for
optimal function.
• Continue with stretching exercises to maintain flexibility.
2. Advanced Balance and Coordination:
• Progress to more challenging balance exercises and agility
drills.
• Focus on dynamic movements to enhance coordination.
QUADS STRETCHING
 3. Sports-Specific or Activity-Specific Training (if applicable):
• Tailor the rehab program to the individual’s sports or activity
goals.
• Gradually reintroduce specific movements and activities.
4. Continued Strength and Conditioning:
• Maintain a regular strength and conditioning program to
sustain progress.
• Continue monitoring and adjusting the program based on
individual needs.
 REFERENCE
1. Textbook of orthopedics 4th edition-2010 by John Ebnezar.
2. Patellectomy: An Overview With Reconstructive Procedures
Clinical Orthopaedics and Related Research 389: p 74-78,
August 2001.
3. Clinical orthopedic rehabilitation, S.Brent Brotzman, Robert
C. Manske. 3rd edition
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