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Principles

Treatment goals

The patello-femoral joint is biomechanically very stressed when the knee is loaded. Any compromise of the joint surface is likely to lead to degenerative joint disease. It is, therefore, highly desirable, in patellar fractures to strive for anatomical reduction of the joint surface and stable fixation.

In wedge or multifragmentary complete articular fractures, anatomical reduction of the joint surface in relation to all the fragments, combined with durable restoration of the integrity of the extensor mechanism is not commonly achievable.
K-wires with heavy sutures applied in standard "tension band configuration" draws the fragments together as anatomically as possible and permits controlled quadriceps rehabilitation in the medium to late healing phases. The joint surface commonly heals with some irregularity, predisposing to secondary degenerative joint disease.

An additional treatment goal is restoration of function of the knee extensor mechanism and allow early range of motion of the knee.