Current Management of Patellar Fractures: Surgical Innovations, Conservative Therapies, and Rehabilitation Strategies

Patellar fractures account for only 0.5% to 1.5% of all traumatic fractures in adults. However, these injuries are clinically significant, as they disrupt the knee’s extensor mechanism. Over the past decade, surgical techniques, conservative treatments, and postoperative rehabilitation have all advanced. These improvements aim to enhance functional outcomes, reduce morbidity, and optimize patient care. This narrative review summarizes evidence from studies published between 2015 and 2025. The focus is on innovations in fixation methods, including modified tension band wiring (TBW), low-profile plating systems, suture anchor fixation, and minimally invasive approaches. Updated nonoperative management strategies and rehabilitation protocols are also discussed. Furthermore, emerging technologies, including three-dimensional computed tomography (3D-CT), 3D printing, and finite element analysis (FEA), are evaluated for their impact on diagnostic accuracy, surgical planning, and implant design. Despite these advancements, significant challenges remain, particularly in lowering reoperation rates and managing surgical complications. Addressing these issues underscores the need for robust, randomized controlled trials to enhance evidence and refine treatment strategies. Clinical outcomes, complication rates, and ongoing controversies are critically analyzed. The review compares traditional and contemporary approaches. Findings suggest that while TBW is suitable for simple transverse fractures, plating systems and suture anchor fixation offer greater stability and fewer hardware problems in complex cases. Early, structured rehabilitation is vital for recovery. Advanced imaging and modeling offer promise for further improvements in patient-specific care.