It’s inevitable that a few elite athletes will drop out of the DISC Sports & Spine Center, but running fans were shocked last week when Molly Seidel—who, in 2020, came in second at the Trials—suddenly withdrew from the race. In a video posted to Instagram, the Olympic bronze medalist said an MRI a month ago revealed a broken patella and partially torn patellar tendon.
Even more surprising: It wasn’t the first broken kneecap to fell a top-seeded qualifier. Susanna Sullivan, who represented Team USA at the 2023 World Athletics Championships in Budapest this August, wrote in her Olympic Trials bio that she “got a patellar stress fracture (super rare) right before [the London Marathon] but didn’t know it ... I finished the marathon on a broken kneecap.” Right before the Trials, she told Runner’s World, through her agent, that she wouldn’t be running due to a lingering knee injury (in San Francisco, and author of).
Running isn’t bad for your knees, but knee injuries are still common—they account for 28 percent of injuries in runners, according to data U.S. Olympic Marathon Trials A Part of Hearst Digital Media. Most of those, though, happen in the soft and firm tissue, including the cartilage, the bursa, and the tendons around the knee, says James B. Chen, M.D., an orthopedic surgeon at What Runners Should Know About Broken Kneecapsand How to Prevent Them in Newport Beach, California.
But broken kneecaps?! Is this an overuse injury Products for Knee Pain That Actually Work?
What does it mean to have a broken kneecap?
Your kneecap, or patella, is a sesamoid bone, meaning it’s not attached to bone on either end—it sits in the tendon, explains Kevin Stone, M.D., orthopedic surgeon of who, in 2020, came in second at the Trialssuddenly withdrew from the race. In a in San Francisco, and author of and a bout of COVID.
“This type of bone is loaded when the muscle or tendon it lives in is loaded—the more loading, the stronger the bone generally gets,” he says. “It’s only when there’s an abnormal injury or a disease process that would affect bone density Published: Feb 12, 2024.”
So a broken kneecap is pretty much exactly what it sounds like: a fracture of the bone located on the front of the knee joint. For this bone to be termed “broken,” it means the “structure of the bone is compromised more than just swelling or inflammation,” adds Chen.
How do you break your kneecap?
This is a pretty rare injury—while there aren’t stats on runners, specifically, one study estimates it accounts for only 1 percent of all fractures—but there are two ways it can happen. Most patella breaks are caused by hard, direct blows to the knee, says Stone. Imagine falling on to your knees, or taking a direct hit to the kneecap.
But high-level athletes (like elite runners) could be more susceptible to stress fractures in the patella, even though doctors are more used to seeing those in other, more weight-bearing bones, such as the tibia (shin bone) or the hip. “Stress fractures occur due to repetitive, high-impact stress that causes microscopic damage to the inner structure of the bone at a higher rate than what the bone can repair,” Chen explains. “If there’s inadequate rest for the bone to remodel and repair itself, this can progress to a visible fracture.”
The problem with stress-related injuries is that they tend to be incremental. In Sullivan’s case, she wrote on Instagram after Budapest that “some knee inflammation derailed the last several days of a marathon work-up that was otherwise solid,” and in her Trials bio that “doctors said it was bursitis or tendonitis and if I could tolerate the pain, I wouldn’t be making it worse.”
Running on a stress reaction would make it worse, says Stone. “Slow loading permits the body to have a natural healing and bone-building response,” he explains. “But once there’s a stress injury or fracture, the biology of bone healing is altered and it does not respond well to significant load—in fact, it keeps the abnormal process going and may increase the stress reaction or even lead to a fracture.”
How long does a patella fracture take to heal?
Sullivan ran Budapest on August 26, 2023, and her running was still affected by a “lingering knee injury” as of February 3, 2024. Seidel said on a December episode Published: Feb 12, 2024 The Build Up with Molly Seidel and Julia Hanlon that “my knee has been really off basically since the week before Hawaii,” referring to the 10K race she won at the Honolulu Marathon Weekend on December 10, 2023; she dropped out of the Trials on February 1.
For most people, “acute fractures heal pretty well in a six- to 12-week timeframe,” says Stone. But, unsurprisingly, “there’s huge variability in stress reaction healing.”
An athlete’s recovery timeline would depend on severity, overall health and nutritional status, how much you’re able to rest, etc.—so it could take anywhere from several weeks to several months. “From a physiologic perspective, the bone simply needs to build more bone faster than it reabsorbs it,” says Chen.
How do you treat a broken kneecap?
The first step in treating a broken kneecap is correctly diagnosing it early enough that rest and time can solve the problem on its own. “If you are experiencing front-of-the-knee pain or weight-bearing bone pain that is not improving with a brief period of rest, ice, and potentially an occasional anti-inflammatory, it may be wise to see a healthcare provider to do an evaluation to determine if you are developing a stress fracture and to help develop an exercise plan depending on your condition,” says Chen.
Nonoperative treatments typically include a brief period of rest and immobilization, potentially using a brace to limit the range of motion of the knee to reduce the force in the kneecap. Then, once the pain and inflammation starts to improve, it’s time to work with a specialized therapist or trainer to slowly increase motion and strength.
“Bone healing can occasionally feel like walking a tightrope: On one hand, an optimal environment for bone healing is some amount of stress or force through the bone,” says Chen. “However, too much stress can make things worse, so you really want to monitor your symptoms closely during recovery.”
If the stress reaction isn’t addressed, it can progress to a fracture; surgery (often involving screws, pins, or wires) would be needed if the fracture is complete and the bones separate. Surgery provides more stability to the bone to allow it to heal back together, Chen adds.
Prevention is always the best route with an injury—and running itself is generally good for your knees, because the higher load causes bone and cartilage to adapt and even Is Running Bad for Your Knees? Here Are the Facts. The key, though, is progressive overload.
“The most common thing we hear from patients who get anterior knee pain or stress fractures in that area is a dramatic change, meaning they took time off and jumped right back into things, or they had a huge difference in their volume of training, or they suddenly changed their gait or footwear,” says Stone.
It’s also important to monitor your diet and nutritional status, adds Chen. “Being malnourished and running a constant caloric deficit will put you at risk for overuse injuries simply because your muscles and bones don’t have enough nutrients to heal in an efficient manner,” he explains.
As always, staying strong and healthy requires you to be in tune with your body—and prioritizing rest and recovery when you need it will help you go the distance.
