Runner suffers shockingly rare double kneecap break in off-road race

Monday, 5 January 2026

Sierra Ryland had beaten barbed wire, crawled through mud, and hauled herself by rope up a local hill known as Everest ‒ then she broke both kneecaps.

The Wellington woman has spent the last six months recovering from an extraordinarily rare injury suffered during an off-road run in Wainuiomata, one which takes competitors across farmland, through native bush, and up a vertiginous, slippery climb known as Mt Everest by locals.

Ryland, a personal trainer and World Ironman age group champion, was part of a team taking part in May’s Tough Guy and Gal challenge, an annual “mud” race that, in an individual capacity, she had won three years in a row.

She had been experiencing soreness in both knees‒“it was a bit odd, but nothing major”‒for about two weeks before the race. A physiotherapist suspected running tendonitis or runner's knee and advised rest.

Rest for Ryland, who is also a running and triathlon coach and the mother of a 7-year-old, is not like rest for most of us, however.

“I said, well can I do this race at the weekend? It’s just a bit of fun…he was like, yeah your knees will just hurt.”

Plus she reckoned she would get some downtime on a planned post-race family holiday in Fiji.

“So I rested till the race. At the warm up I practised climbing up and down things and jumping off things. It felt fine, I wasn’t in too much pain.”

Hitting her stride after some jostling at the start Ryland was in second place as she crested “Everest”.

“To get up the hill, you're using ropes to pull yourself up, and then you just kind of run/fall/slide down the other side, depending on how wet and slippery it is from the rain.”

While her knees were hurting, as predicted, the pain was bearable and wasn’t getting worse. “So I just thought, okay, I’ll let go on the downhill and try to catch the runner in front of me.”

That exuberance wasn’t to last. Ten strides on and Ryland heard the first crack. As her other leg pulled through she heard another crack.

“I fell over to the side and had a sort of moment where I was screaming in pain, but also as a runner going ‘oh my god. No, no, oh no’… and then the pain stopped.”

Thinking she had over-reacted and her legs had just buckled under her Ryland tried to move. “It was excruciating. My kneecaps looked like they were in places that they shouldn't be in.”

As the race continued around them paramedics manoeuvred her down the track to a waiting ambulance, where she was administered ketamine, a strong sedative, to relieve her pain.

Initial thoughts were that Ryland had dislocated her kneecaps; X-rays later found she had snapped them both in half-what’s known as a bilateral simultaneous patella fracture, an extremely rare injury.

While it was a worse case scenario for the mad-keen runner, her surgeon also had some “good news” .

“I think the first thing I asked him when I woke up was can I still go to Fiji? And I remember him saying when they opened up my knees that yes, it looked liked a bomb had gone off. But I hadn’t ruptured any tendons or ligaments, and there were no other broken bones…”

Ryland spent two weeks in hospital in full leg braces, six weeks in a wheelchair fitted with an extension to keep her legs straight out in front of her “literally crying every day” and another six weeks in a wheelchair able to bend her legs but “basically stuck inside the house” as she and her husband negotiated with ACC to get a ramp put in.

“We only have one step into the house, but if I had to go to physio appointments or anything I had to make sure my husband was at home because other drivers weren’t going to lift me. We ended up borrowing some trailer wedges from a friend to at least have some sort of ramp.”

Ryland has spent hundreds of hours getting back her fitness and trying to build back muscle, starting with with triceps dips in her wheelchair, “tiny movements that felt almost laughable”.

She has only just begun walking without crutches, and while able to return to work, albeit on the sidelines, still finds it difficult to walk downhill or down stairs. Doctors expect it will be another six months before the wired tension bands holding the bones in place can be removed.

“If I reflect on it, it's still very emotional. I don't really have that much trauma around the actual injury. I have way more trauma about the recovery process because it's so long and so uncertain. The surgeon initially gave me a time line of a year, but because they've never seen it before and normally they’re dealing with people with one good leg, they just don't know how things will progress.”

Ryland’s physiotherapist Tim Dalman said he had never seen even a single kneecap break like hers in his 20-year career, “let alone two.That is pretty crazy. It’s certainly something not many people [worldwide] have seen. Basically every time it has happened it’s been written about in medical literature because it’s so rare”.

While Ryland had since been diagnosed with premature ovarian insufficiency, a potential pre-cursor to osteoporosis, her earlier pain had indicated patellar tendon overload (combined stress from the quadriceps tendon and patellar tendon) rather than stress fractures normally associated with similar bone breaks.

However the severity of the injury suggested she probably did have a bilateral stress fracture “otherwise it wouldn’t just snap like it did,” Dalman, who co-presented a paper about the case, at a medical conference in November, said.

As for that holiday in Fiji? Ryland and her husband spent a week there in October. “I still couldn’t do a lot, like walk on the beach, but we got there, at least.”

And to top off a year of first,s Ryland was named personal trainer of the year at the Exercise New Zealand Industry Awards last month, recognising her “dedication to empowering women, and her specialised expertise in MumSafe training, postpartum running and female-specific performance”.