1. { Chris Sheedy, Allison Leeming, Alex Smaridge

2.   The knee is composed of four bones that come together to create the joint, fibula, tibia, patella and femur. Stability of this joint is maintained by four ligaments: the medial collateral ligament, the lateral collateral ligament, the anterior cruciate ligament and the posterior cruciate ligament. There are two menisci, pieces of cartilage, located on the inside of the joint that provide shock absorption that sit on the top of the tibia. Bursas, fluid filed sacs, surround the joint and are used to cushion the knee in its range of motion. One bursa is located between the patella and the skin called the prepatellar bursa and another above the patella called the suprapetellar bursa. How the Joint is Put Together

3. The Knee Joint

4.   A fracture of the patella usually results from a blunt trauma to the knee, or in other words, a powerful direct blow to the knee with a very strong object. Injuries such as this can occur during a car accident when the victims’ knees hit the dashboard, during sports accidents or falls, or from being hit by any sort of heavy object. In rare cases, even a strong sudden contraction of the quadriceps muscles may be enough to crack the patella to which they are connected. How the Injury Occurs

5. During Sports! Oucchhh… The faces all of you are making right now -->

6.   If an athlete is suffering from a fractured patella, some of the immediate symptoms would be sudden, intense knee pain accompanied by intense swelling. Tenderness of the knee may be felt even only 5 – 7 days after an activity, and the victim will experience difficulty bearing weight on the affected leg, and difficulty bending the knee. Symptoms of the Injury

7.   A patella fracture, like most other bone fractures, inhibits most or all movement in the leg of the sufferer, though different levels or grades of the injury precipitate different levels of damage. There are four different grades of patella fractures, the first being a stable fracture.   In a stable fracture, the affected bone is not displaced from its original position, but merely cracked or separated. In this case, the broken ends of the bone usually line up directly in the fashion they were before, and healing from this type of fracture is much simpler than in other circumstances.   The next class of patella fracture is a displaced fracture. A displaced fracture is still on the less serious side of breaks, but more severe and worrisome than a stable fracture because the broken pieces of the patella, in this case, do not line up. These types of fractures often require surgery for the bones to be realigned.   The third class of fractures is a comminuted fracture in this type of fracture, the bone in question is shattered into three or more pieces, and will definitely require surgery to be fixed. Classifications of Joint Injury

8.   Lastly, the worst kind of fracture would be an open fracture, in which there is bone protruding through the skin that is in contact with open air. Also, these types of breaks usually involve severe damage to surrounding tendons, ligaments, and muscles.   In addition to different classes of fractures of the patella, there are other types of injuries that can occur in this area such as:   Ligament strains: Grade One: stretch of the ligaments but no tear   Grade Two: partial tear tot eh ligaments but they remain intact   Grade Three: the ligaments are completely torn   Cause: over stretching the ligaments   Cartilage tears: twisting puts stress on the cartilage, which can cause it to be pinched between the tibia and the femoral condyle causing tears.   Tendon strains: First degree: stretching but no tearing of muscle or tendon   Second degree: stretching and partial tearing of muscle or tendon   Third degree: fully tearing the muscle or tendon   Cause: hyper-flexion, hyperextension or overuse   Patello-Femoral Syndrome: increased levels of friction between the patella and the femur, results in knee pain.   Bursitis: inflammation of the bursas caused by direct impact or excessive use Cont’d

9.   If no surgery is needed for the injury then the most common way that knee injuries are treated is with the RICE method, (rest, ice, compression, elevation) along with light strengthening exercises and stretches. Also, crutches are often used by patience recovering from these more minor patella injuries. Surgery is only required if the ligaments, tendons or cartilage have been torn or there is a severe fracture to the patella.   In the case of MCL and LCL injuries, a knee immobilizer to keep the knee straight and stable and RICE are all that is needed for most of these injuries.   For the treatment of ACL injuries, recovery takes months using RICE method and if not monitored properly surgery may be required to fix the damage.   Usually, whether surgery is needed or not will be determined by specially trained doctors, and the need varies greatly from case to case. Sometimes, surgery may not be needed for a seemingly severe injury, while other times surgery may be needed to fix a smaller fracture that could not properly heal itself.Treatment

10.   After the treatment of a patella injury, usually being surgery, the patients are required to keep their knee straight for an extended period of time, and minimal movement of the joint if recommended. In some cases however, (usually the less severe ones) early movement of the joint is recommended to regain strength in the muscles and ligaments surrounding the patella. Some complications for patella surgery can be the metal implants put in place to aid the bone in healing in the correct position, which can become painful over time, infection, non-healing fractures, and knee arthritis. The doctors who performed the surgery will treat these symptoms individually and uniquely as they present themselves. Rehabilitation

11.   Now that surgery is a thing of the past it may be best not to have to ever have to go through that again, ever. Here is how to avoid re-injuring a fractured patella.   In the even that an athlete injures their patella, the best medicine for not injuring it again is preventative medicine. Depending on the severity of the injury a victim may be able to live on without much problem, but in cases of severe injury to the patella victims must be cautious. The athlete will have to make small life styles changes; such as avoiding going up and down stairs and ladders as much as possible.   Things to avoid:   Exercises with deep bending or squatting at the knee   Violent contact with the knee   High intensity activities   Kneeling or landing on the knee   However the victim of a patellar injury can also do the following in order to help strengthen the joint and prevent any further injury.   Going to physiotherapy   Doing exercises that improve strength in the quadriceps muscles to help support the joint   Stretching to improve flexibility and range of motion in the joint   Wearing a knee brace to provide extra support and reduce pain Post-Rehabilitation Prevention

12. POP QUIZ! :D 1.What is the most common cause of patellar fractures? 2.Can you name off the classes of patellar fractures? 3.Do you remember the most popular course of treatment in patellar injuries? :O 4.Name three things to avoid after recovering from knee treatment.

13. Question! Has anyone here ever injured their patella?