From the Research
Bipartite patella is a normal anatomical variant that can become symptomatic, particularly in athletes, and may require treatment to alleviate pain and improve quality of life, with surgical intervention such as excision of the smaller fragment or fixation of the fragments being a viable option for persistent cases, as supported by the most recent study 1.
Overview of Bipartite Patella
Bipartite patella is a condition where the patella appears to be divided into two separate parts on imaging studies, occurring in approximately 2% of the population, and is most commonly found in the upper outer portion of the patella. This condition results from the failure of secondary ossification centers to fuse during skeletal development, typically between ages 12-16.
Significance and Treatment
Most cases of bipartite patella are asymptomatic and discovered incidentally on X-rays obtained for other reasons, requiring no treatment. However, in some individuals, particularly athletes who participate in activities involving repetitive knee stress, the fibrous connection between the fragments may become painful. When symptomatic, treatment options include:
- Activity modification
- Physical therapy
- Anti-inflammatory medications In persistent cases that don't respond to conservative measures, surgical intervention may be considered, with excision of the smaller fragment or fixation of the fragments being a viable option, as shown in the study by 1, which reported excellent outcomes in the majority of cases.
Diagnosis and Distinction from Other Conditions
It's essential to distinguish bipartite patella from an acute patellar fracture, which can be done by noting the smooth, well-corticated margins of the bipartite fragments versus the irregular edges of a fracture. Magnetic resonance imaging (MRI) is a valuable diagnostic tool for evaluating detailed morphologic and pathologic changes in patients with bipartite patella, as highlighted in the case report by 2.
Quality of Life and Outcomes
The goal of treatment is to alleviate pain and improve quality of life, with surgical intervention resulting in excellent outcomes, including relief of pain and return to preoperative activity levels, as reported in the study by 1. The study found that fragment excision of less than 12% of the whole patella with or without lateral release resulted in excellent outcomes in the majority of cases, with an average preoperative and postoperative Lysholm score of 75 and 93, respectively.