Knee Brace Use After Surgical Patellar Fracture Repair
A knee brace is not routinely recommended after surgical correction of patellar fractures when the extensor mechanism is intact and the fixation is stable; instead, immediate mobilization and early rehabilitation should be prioritized.
Clinical Decision Algorithm Based on Fracture Classification
The treatment approach depends on three critical factors that determine whether bracing is needed 1:
When Bracing is NOT Needed (Most Common Scenario)
For fractures with intact extensor mechanism and stable fixation (Type I):
- No brace is required 1
- Immediate mobilization should begin 2
- Nonoperative management without bracing is successful in nearly all cases 1
- Only 1 late failure occurred among 37 cases treated without bracing 1
When Bracing MAY Be Considered
For fractures with disrupted extensor mechanism (Type II):
- Operative repair is typically required 1
- Post-operative immobilization may be needed initially, but evidence for prolonged bracing is lacking 1
- High complication rate (50%) and reoperation rate (45%) regardless of bracing approach 1
For fractures with loose patellar component (Type III):
- Operative intervention is usually necessary 1
- Similar high complication rates exist regardless of bracing 1
Why Bracing Should Be Avoided When Possible
The evidence strongly argues against routine immobilization or bracing after knee surgery:
Impedes rehabilitation progress:
- Knee immobilizers provide no benefit after knee surgery and may delay rehabilitation 2
- Bracing after ACL reconstruction showed no improvement in outcomes, function, or stability 3
- Patients without braces achieved free range of motion significantly earlier 4
Creates functional deficits:
- Immobilization causes quadriceps muscle atrophy 5
- Restricted motion leads to worse functional outcomes in the first 6 months 5
- No differences in stability or muscle strength at long-term follow-up between braced and non-braced groups 6, 4
What You Should Do Instead
Immediate mobilization protocol:
- Start rehabilitation on the day of surgery 2
- Begin immediate knee mobilization within the first week 3
- Allow early weight-bearing as tolerated within the first week 3
Active exercise program:
- Initiate isometric quadriceps exercises in the first 2 postoperative weeks 3
- Progress to closed kinetic chain exercises (leg press) starting at 3 weeks 3
- Implement supervised exercise program during the first 2 months 2
- Focus on strength and neuromuscular training throughout recovery 3
Common Pitfalls to Avoid
Do not continue bracing based on tradition alone:
- The American Academy of Family Physicians warns against continuing bracing based on surgeon preference when evidence doesn't support benefit 3
- Avoid creating psychological dependence on the brace, which provides false security 3
Do not substitute bracing for proper rehabilitation:
- Lower extremity muscle strengthening and flexibility improvements are more important than bracing 7, 8
- Bracing cannot replace appropriate rehabilitation and muscle strengthening 3
Special Context: Patellar Dislocation vs. Fracture
The evidence provided includes studies on patellar dislocation, which differs from surgical fracture repair. For traumatic patellar dislocations treated conservatively, motion-restricting braces showed no reduction in redislocation rates compared to simple neoprene braces, but caused more quadriceps atrophy and worse early functional outcomes 5. This further supports avoiding restrictive bracing even in patellar pathology.