Painful bipartite patella following injury

Excision of Painful Bipartite Patella: Good Long-term Outcome in Young Adults

“…We found an incidence of unresolved painful bipartite patella of 9.2 per 100,000 recruits. The amount of literature dealing with the existence and surgical excision of bipartite patella in skeletally mature patients is small and consists mainly of case reports [3,11,13]. The principal finding of our study was surgical excision of the accessory patellar fragment resulted in excellent or good functional long-term outcome in all but one patient.…”

“…A bipartite or multipartite patella is estimated to have a prevalence of 0.2% to 6% in an adult population [9,15,28]. Most bipartite patellae are asymptomatic [30] and a clinically irrelevant anatomic variant [9,13,28]. The partition is considered the result of an accessory ossification center failing to fuse with the primary patella during adolescence [2,8,10,24], but alternative explanations have been offered such as trauma and nonunion [7,26], tendinous traction [22,26,28,29], vascular insufficiency [26], or some combination [5].…”

“…Nonoperative treatment is preferred, especially for adolescent patients and patients with a more gradual onset of symptoms [23]. When nonoperative treatment fails, surgery reportedly provides good relief from symptoms, even after a duration of symptoms of up to 11 years [13]. In cases of acute and sudden pain, often trauma-related, surgery is preferred by some [13,30] and one study suggests it relieves symptoms [13].…”

“…When nonoperative treatment fails, surgery reportedly provides good relief from symptoms, even after a duration of symptoms of up to 11 years [13]. In cases of acute and sudden pain, often trauma-related, surgery is preferred by some [13,30] and one study suggests it relieves symptoms [13]. For treating larger fragments, or fragments with little mobility, diverse surgical techniques aimed at decreasing traction on the fragment have been developed during the last decade [1,21,22], and in some cases with large lateral fragments, internal fixation has been used [6,14].…”

“…Excision of the accessory bipartite fragment has remained the most widely used surgical method of treatment [1,3,21], especially in skeletally mature patients. Elimination of symptoms after excision has been reported in 0.5-to 5-year followups among adolescents [9,14,22,23,30] and adults [13]. One study reports complete pain relief in long-term followup after excision for 13 of 16 skeletally immature adolescents [5].…”