On Saturday, May 13th it was revealed that Browns rookie defensive back, Howard Wilson, had incurred a fracture of his patella. The Browns initially were afraid Wilson would be unable to avoid surgery, however, new reports from the team indicate the fracture is not as serious as initially feared and will not require surgery.
What is it?
The patella (knee cap) is the largest sesamoid bone in the body and is located on the front of the knee. Sesamoid bones are found within a muscle or tendon; in this case, the patella is found in between the quadriceps tendon and the patellar tendon. The quadriceps tendon connects the patella to the quad muscle on the front of the thigh and the patellar tendon connects the patella to the lower leg. The knee cap serves an important role as a lever in order to allow the quadriceps muscle to generate force to straighten the knee completely. A fracture refers to a break in a bone and can be classified based on the severity of the injury. Fractures can be displaced or non-displaced, with displaced referring to a fracture which breaks into two or more pieces, which separate and no longer line up properly. Non-displaced fractures involve the breaking of a bone, however, the pieces involved in the fracture remain in line and do not move out of place. A fractured kneecap refers to a broken patella. The most common mechanism of injury is direct trauma to the front of the knee.
How is it fixed?
Treatment for fractured patellas is based on severity with less severe fractures being treated conservatively via rest and rehabilitation and more severe fractures being addressed surgically. Initially, conservative management of a broken kneecap will typically include a period of immobilization of the knee via a cast or splint. This will ensure, the non-displaced fracture does not move further and create a more significant injury. Additional physical therapy goals during the early stages of rehab include pain control, range of motion exercises for the knee, within the confines of the physician’s protocol, and strengthening exercises for the musculature of the hip. The ability to bear weight through the effected limb early on may vary from one physician to another. Once cleared by the physician, the patient may advance to phase two of the rehabilitation process which includes quadriceps strengthening, continued strengthening of the hip, as well as range of motion exercise for the knee and gait (walking) training. As the individual is able to demonstrate the ability to perform and complete all physical therapy goals they will continue to advance towards a return to sport. A conscious effort is made by the physician to ensure proper bone healing occurs by evaluating x-rays at each follow up visit. Ultimately, bone healing will also help dictate progression through rehab; if poor bone healing has occurred an individual may not be allowed to progress to the next phase of rehab as quickly. Typical bone healing can take up to 8-12 weeks. The final phase of rehab involves return to sport specific activities. The individual must receive clearance from the medical team before advancing to sport specific training in physical therapy. After successfully completely a course of rehab the individual is cleared to return to practice and initiate on field activities with the intent to return to live practice and live game repetitions. Specific conservative protocols will vary from physician to physician.
The Browns and rookie Howard Wilson dodged a bullet here. It was initially feared that Wilson’s injury would require surgery, however, this is no longer the case. If Wilson is able to successfully work through the rehab process without setback, I am confident we will see the Desoto, Texas native suit up and see game action before the midway point of the season. An initial timetable has been set at a 12-16 week recovery window.
We will continue to monitor the status of Howard Wilson as he progresses through the rehab process and will provide the most up to date injury analysis and breakdown as new information becomes available.
Brandon Bowers, PT, DPT, is a graduate of the University of Toledo, Doctor of Physical Therapy Program and currently practices in Columbus, Ohio. He is an avid Cleveland sports fan and has experience rehabbing athletes of all levels and from a variety of sports. Follow Brandon on Twitter for more Cleveland Browns injury insight and analysis: @blbowers12
The information provided is the professional opinion of Brandon Bowers, PT, DPT and is based on his clinical experience and the most current clinical evidence available. This information should not be interpreted as or substituted for medical advice for a specific condition or diagnosis.