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In a retrospective analysis of 70 patellar fractures the-long-term results after surgery were followed-up for periods of up to twelve years. Subjectively, excellent or satisfactory results were reported by 89% (n = 62) of patients. Clinical evaluation in the Lysholm score showed excellent or good results in 74.2% (n = 52) of cases. The results in the Lysholm score correlated well with the radiological evidence of arthrosis (p < 0.014) and with the clinical signs of chondropathy (p < 0.0005). Poor results (79.2 Lysholm points) were seen for comminuted fractures; however, the results for patients with distal transverse fractures were even lower (68.28 Lysholm points). Medial transverse fractures as well as distal patella pole ruptures were shown to have good prognostic results. In cases with comminuted fractures resection techniques are to be preferred to conservative procedures (p < 0.015). As regards long-term results in our patient population, partial patellectomy showed no obvious advantages over total patellectomy. In cases with multi-fragment fractures with questionable possibilities for reduction, cases with extensive cartilage damage as well as cases with distal transverse fractures partial or full patellectomy is recommended as the therapy of choice.