Non-Operative Patella Fracture

Physical Therapy Protocol

Phase 1: Weeks 0–4

Range of Motion (ROM):

• Hinged knee brace locked at 0 degrees
• Intermittent active and active-assisted flexion with passive extension for 5–10 minutes, 4 times daily
• Patellar mobilization activity
• Remain within 0–45 degrees of ROM

Strengthening:

• Isometric hamstrings using an endurance protocol: 10–40 repetitions per set, 5 sets per day

Weight Bearing:

• 100% weight bearing with brace locked in full extension

Modalities:

• EMG biofeedback to hamstrings (not quadriceps), as needed
• Electrical muscle stimulation (EMS) to hamstrings, as needed
• Cryotherapy

Sports:

• None

Phase 2: Weeks 4–6

Range of Motion (ROM):

• Advance ROM as tolerated
• Brace locked in full extension when ambulating only

Strengthening:

• Initiate quadriceps strengthening
• Begin straight leg raises (SLR)

Weight Bearing:

• 100% with brace locked in full extension

Modalities:

• As needed (per Phase 1)

Sports:

• None

Phase 3: Weeks 6–8

No specific details provided. Progression from Phase 2 assumed.

Phase 4: Weeks 8–12 (and beyond, if applicable)

Range of Motion (ROM) and Brace Use:

• If not already weaned off brace, continue exercises and strengthening to facilitate discontinuation
• ROM and strengthening as tolerated

Modalities:

• As needed

Sports:

• Progress through a graduated running program (e.g., functional rehabilitation program)
• Resume primary sports if:
  • Near full ROM is achieved
  • At least 80% quadriceps and hamstring strength compared to the opposite limb

Return to Sport:

• Typically by 3–4 months
• May include progression through work conditioning, if applicable