Symptomatic Bipartite Patella in Adults Treated With Open Excision: Outcomes and Management

Abstract

IntroductionBipartite patella affects about 2% of people. Most cases are asymptomatic; however, some develop anterior knee pain during a sporting activity or trauma. When conservative treatment fails, surgery can be considered. This study aims to report the outcomes of fragment excision with or without lateral release in adults with the symptomatic bipartite patella. MethodsThe study was approved by the College of Medicine IRB. A retrospective review was performed. Patients were excluded if aged < 18 or had prior knee surgery. Data collected included: age, gender, BMI, sports played, occupation, physical exam findings, Saupe classification, conservative and surgical treatment, advanced imaging used, duration of follow-up, Lysholm score and postoperative complications. ResultsEight patients were studied. The average age was 28.4 years and BMI was 31.5. Sporting activities included hunting, swimming, soccer, golfing and softball. Occupations included office job, laborer, manufacturing plant worker and truck driver. All patients complained of anterior knee pain exacerbated by sports or work. All patients failed >6 months of conservative treatment. Saupe classification included seven types III (superolateral) and one type II (lateral). Surgical treatment included one open excision, six arthroscopicassisted open excisions and one arthroscopic-assisted open excision with the lateral release. The duration of follow-up averaged 15 months. The average preoperative and postoperative Lysholm score was 75 and 93, respectively. One postoperative complication occurred. ConclusionsBipartite patella is an uncommon cause of anterior knee pain in adults. When pain persists despite conservative care, fragment excision of less than 12% of the whole patella with or without lateral release resulted in excellent outcomes in the majority of cases.

Painful knee

“…Wenzel Gruber discovered the BP for the first time in 1883 in St. Petersburg, Russia, while performing an autopsy on a 21-year-old farmer who had a tiny bone fragment attached superolaterally to the patella [ 9 , 15 ]. Kempson described it as emargination and an accessory patella in 1902 [ 16 ].…”

“…It occurs bilaterally in 50 % of patients. It is more common in men than in women [ [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] ].…”