Introduction

It has previously been reported by the author that human long bone fracture can be managed non-operatively by LLLT [1] in this journal. The present clinical case series of six adult patients all with displaced transverse fracture patella but intact extensor mechanism on presentation who refused surgery and reluctant to have 6 weeks plaster all were treated solely with LLLT treatment for 6 weeks together with a locked hinge brace (Fig 1) for the initial 3 weeks. The clinical efficacy of LLLT in tackling these problems without the need of open reduction, nor complete casting would proof to be rewarding in reducing the suffering of subjects who dislike operative intervention.

Figure 1

Materials and Methods

The study period spans from 2020 to 2025, consisting of patients attending the wellness pain centre. The male:female ratio was 1:5 and the mean age was 68 (range 57 to 71). All the parents refused complete casting and consented for LLLT treatment spanning 6 weeks. LLLT was provided by a GaAIAs semiconductor device emitting 810 nm wavelength, 5.4 J per point, and power density of 20 mW/cm2 was used and the duration of application of LLLT over the fracture site was 360 seconds administered on twice weekly basis to the fracture site, without the use of other oral medications excepy paracetamol. Skin wounds have their dressing changed during each clinic visit, none were open fractures. All fractures occurred were of the common transverse orientation in this study, the right patella was affected in 2 out of 6 cases. Exclusive criteria included open fractures or MRI evidence of other concomitant injuries like ligament or meniscus injury.

Serial radiographs were taken every week to assess the degree of bone healing if any. No other physiotherapy treatments were administered other than FDA approved LLLT devices. The use of control by sham light source was objected by the majority of subjects and thus sham light irradiation was not employed. All patients had minimum follow up of 3 months to assess clinical results in terms of pain level, deformity if any, and the degree of bony healing of the affected bone over time compared with the contralateral side.

Results

All subjects completed the LLLT treatment of 6 weeks without side effects. Treatment failure is defined by failure to obtain radiological bone healing that necessitated open reduction. In this study, there were no defaulters, and 6 out of 6 subjects demonstrated good bony responses to LLLT. Fig 2 illustrates a typical patient with Transverse Patella Fracture showing Bony-Bridging Callus forming at the 3 times mark with no displacement of the bony fragment. All subjects patella fracture went on to solid union at 6 weeks.

At the 3 month follow up mark, there was no pain in all patients, and equal lower limb quadriceps power of both lower limbs, all subjects were satisfied with the result.\

Fig 2 illustrates a typical patient with Transverse Patella Fracture showing Bony-Bridging Callus forming at the 3 times mark with no displacement of the bony fragment.

Figure 2

Discussion

It is common teaching in Orthopedics that open reduction and internal fixation is a must for displaced transverse fracture patella. This study illustrates that as long as the subject had intact extensor menchanics and without open fracture, and fracture separation </= 4 mm then LLLT can actually heal the fracture amid a relatively intact fracture haematoma.
The author had previously reported in a book publication [2] that LLLT can augment the healing of human upper and lower extremity fractures. The result of this study highlights the fact that LLLT can be used to enhance bony healing even in bony injury around the sesamoid bones like that of the patella. To stress yet again, LLLT can enhance bony healing by various mechanisms including an increase in BMP2-induced phosphorylation of the Smad 1/5/8 pathway [3] as well as stimulate BMPs-induced expression of type 1 collagen, osteonectin, and osteocalcin mRNA [4] besides improving bone mineralization [5].

Conclusion

The administration of low-level laser therapy for 6 weeks was shown to be effective in enhancing bony healing of displaced fracture patella in the adult population without recource to operative fixation that itself involved second surgery for implant removal. LLLT was also demonstrated to remodel and heal even displaced fracture patella in face of intact fracture haematoma. Finally, the 3 month follow up showed good clinical result with no pain, nor deformity and full lower limb function in all patients.