What is the treatment for symptomatic bipartite patella?

Treatment for Symptomatic Bipartite Patella

Conservative management should be the first-line treatment for symptomatic bipartite patella, with surgical intervention reserved for cases that fail to respond after 3 months of appropriate conservative therapy. 1

Initial Conservative Management (First 3 Months)

• Exercise therapy focusing on quadriceps strengthening should be the cornerstone of treatment, including both open and closed chain exercises 2
• Progressive loading exercises should be modified based on pain response 2
• Patellar taping can provide short-term relief of pain and improved function 2
• Patellofemoral braces may help resist lateral displacement of the patella and provide subjective improvements in pain 2
• Prefabricated foot orthoses may be considered for patients who respond favorably to treatment direction tests 2
• Activity modification to reduce patellofemoral joint loading is essential during the healing process 2
• NSAIDs may be used for pain management during the acute phase 3

Monitoring and Follow-up

• Patients should be informed that recovery with conservative management typically takes approximately 1.9 months (median time to resolution) 1
• Conservative management is successful in approximately 76% of cases 1
• Regular follow-up is necessary to assess response to treatment 1

Surgical Management (For Persistent Symptoms >3 Months)

When conservative management fails after 3 months, surgical intervention may be considered based on the specific characteristics of the bipartite fragment:

• Surgical options include:

  • Arthroscopic or open excision of the painful fragment (most common approach) 4, 5
  • Screw fixation for large fragments with articular surface 1, 5
  • Synchondrosis drilling 1
  • Lateral retinacular release 1, 5
  • Detachment of vastus lateralis insertion 5

• Surgical approach selection considerations:

  • Fragment size and location (based on subtypes I, II, or III) 6
  • Presence of articular surface on the fragment 5
  • Patient's activity level and athletic demands 5
  • Arthroscopic approaches may minimize surgical trauma compared to open procedures 4

Outcomes and Expectations

• Approximately 91% of patients who undergo surgical intervention achieve partial or complete resolution of symptoms 1
• Approximately 9% of surgical patients may experience postoperative complications requiring additional management 1
• Some complications may include pain due to trauma, residual symptomatic ossicles, and hardware complications 1
• About 5% of surgical patients may require reoperation (average 2 years after initial surgery) 1

Important Clinical Considerations

• Symptomatic bipartite patella must be distinguished from traumatic patellar fracture, especially in older patients 7
• MRI may be necessary in cases with high suspicion to evaluate for bone marrow edema, quadriceps rupture, or quadriceps fat pad edema 7
• Excision of large fragments with articular surfaces may lead to patellofemoral incongruity and should be approached with caution 5
• Preserving quadriceps muscle strength and patellofemoral joint function should be a priority when selecting treatment approaches 5