Outcomes After Operative Fixation of Complete Articular Patellar Fractures: Assessment of Functional Impairment Lionel E. Lazaro, MD, David S. Wellman, MD, Gina Sauro, PT, DPT, Nadine C. Pardee, BS, Marschall B. Berkes, MD, Milton T.M. Little, MD, Joseph T. Nguyen, MPH, David L. Helfet, MD, and Dean G. Lorich, MD Investigation performed at the Hospital for Special Surgery and New York Presbyterian Hospital, New York, NY Background: Patellar fractures are debilitating injuries that compromise the knee extensor mechanism and are fre- quently associated with poor outcomes. The purpose of this study was to quantify the functional outcomes of operative treatment of patellar fractures. Methods: Functional outcome data on thirty patients with an isolated unilateral patellar fracture were prospectively obtained at three, six, and twelve months postoperatively. Results: All fractures healed. There were two complications (7%) related to the surgery (wound dehiscence and refrac- ture), and eleven patients (37%) underwent removal of symptomatic implants. The tibial plateau-patella angle demon- strated patella baja in seventeen (57%) of the patients. Anterior knee pain during activities of daily living was experienced by twenty-four (80%) of the patients. Clinical improvement occurred over the first six months. However, functional im- pairment persisted at twelve months, with objective testing demonstrating that the knee extensor mechanism on the injured side had deficits in strength (241%), power (247%), and endurance (234%) as compared with the uninjured side. Conclusions: Despite advances in surgical protocols and acceptable radiographic outcomes, functional impairment remains common after treatment of patellar fractures. Rehabilitation strategies following surgical stabilization of these injuries will be a fruitful area for future clinical research. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. P atellar fractures account for approximately 1% of all fractures 1-4 , with 30% requiring operative fixation 4 . These injuries are often associated with poor functional results 2 . Reconstruction of the knee extensor mechanism is the primary aim in treating these injuries 5 . The treatment of patellar fractures continues to evolve, as do opinions regarding the importance of the patella itself in the knee extensor mechanism 4 . As early as 1883, open reduction and internal fixation (ORIF) was recommended to restore knee extensor mechanism function and congruency of the articular surface 6 . In 1909, after reviewing the outcomes of 1100 patellar fractures, Heineck 7 concluded that total patellectomy should be used as a last resort to treat comminuted and displaced fractures. In 1945, Fairbank 8 described patellectomy as de- structive, after too many unsatisfactory results following treatment with excision. In 1971, Kaufer 9 advocated for the preservation of the patella after he demonstrated a 30% decrease of knee extensor mechanism efficacy following patellectomy. Currently, the biomechanical importance of the patella in the knee extensor mechanism is widely acknowledged, and every effort is made to avoid patellectomy. Despite advances in surgical treatment, results of pa- tellar fracture treatment have remained unsatisfactory 2,10-14 . The purpose of this study was to assess and quantify functional outcomes in a series of patients with an isolated operatively treated patellar fracture. Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always1 provided with the online version of the article. e96(1) COPYRIGHT Ó 2013 BY THE J OURNAL OF BONE AND J OINT SURGERY,I NCORPORATED J Bone Joint Surg Am. 2013;95:e96(1-8) d http://dx.doi.org/10.2106/JBJS.L.00012 Downloaded From: http://jbjs.org/ by a HOSPITAL FOR SPECIAL SURGERY User on 10/02/2013