Efficacy of Surgical Interventions for a Bipartite Patella

Abstract

Bipartite patella is a relatively rare phenomenon. This anomaly is typically asymptomatic but can become painful with overuse, strenuous activities, or trauma, which is why it is typically seen in a young, athletic population. Although nonsurgical management is the initial treatment, if symptoms persist, surgical intervention may be necessary. Multiple surgical options exist, such as excision or fixation of the fragment or release of lateral soft tissue structures. The authors report the efficacy of various surgical interventions on a symptomatic bipartite patella, with outcomes related to symptom relief and ability to return to preoperative levels of activity. A systematic review was performed using multiple databases. Studies reporting outcomes of symptom relief or ability to return to activity following surgical intervention for a bipartite patella were included. Surgical technique, type of bipartite, and complications were recorded. Twenty-four articles with a total of 122 patients and 127 knees were included and reviewed. Relief of pain was achieved in 84.1% of patients, with 98.3% able to return to their preoperative activity levels after surgery. For patients with a symptomatic bipartite patella, return to preoperative activity levels with zero to minimal pain can be achieved with excellent results using any of the reported surgical methods.

Arthroscopic Bony Resection for Treatment of Symptomatic Bipartite Patella

“…Excellent outcomes with complete resolution of symptoms was reported in all patients who underwent arthroscopic excision of the fragment similarly to our described technique. 8 A complete return to sport activity was reported in all arthroscopically treated patients, with advantages of the technique including decreased hospitalization time and recovery time as well as the possibility of early rehabilitation. Matic and Flanigan 10 performed a systematic review concerning the rate of return to activity in athletes with a symptomatic bipartite patella.…”

“…For treatment of symptomatic bipartite patella, surgical removal or fixation of the fragment has been described as an effective and successful treatment option. 7 , 8 Furthermore, lateral release of the vastus lateralis muscle and the lateral retinaculum from the fragment may also be performed to ease the strength of forces caused from these adhesions, particularly in cases of lateral or superolateral fragments. 6 A similar procedure was described by Ogata consisting of a subperiosteal detachment of the vastus lateralis muscle's insertion on the fragment.…”

“…In a systematic review performed by Matic and Flanigan, 8 127 patients with symptomatic bipartite patella underwent surgical intervention for symptom relief. The most common procedure included open excision of the fragment in 85/127 patients, vastus lateralis release in 17/127 patients, and lateral retinacular release in 16/127 patients.…”

Operative Treatment of Bipartite Patella in Pediatric and Adolescent Athletes: A Retrospective Comparison With a Nonoperatively Treated Cohort

“…This correlates with conclusions drawn in prior systematic reviews of multiple small case series, in which clinical results suggested comparable overall outcomes across different surgical approaches. 17,18 As stated previously, given the retrospective nature of the study, it was often difficult to identify clear indications for the choice of one procedure over the other. However, all patients had endured prolonged symptoms refractory to a variety of nonoperative treatment measures.…”

Synchondrosis Bither Block: A New Addition in the Diagnosis of Symptomatic Bipartite Patella

“…The conservative treatment is not well defined, but is anything not involving surgery. The use of intraarticular steroids in the presence of bipartite fragment as a part of conservative management is an attempt to exclude other causes before surgical intervention 89…”