From the Guidelines
Bipartite patella should be managed conservatively with a focus on education, exercise therapy, and load management, as outlined in the most recent and highest quality study 1. The condition is a congenital anomaly where the patella develops from two separate ossification centers that fail to fuse during childhood, resulting in a patella that appears divided into two or more fragments. This occurs in approximately 1-2% of the population and is more common in males. Most cases are asymptomatic and discovered incidentally on X-rays taken for other reasons. When symptoms do occur, they typically include anterior knee pain that worsens with activity, particularly climbing stairs or squatting.
Key aspects of management include:
- Objective evaluation to identify key impairments that can influence treatment selection, such as hip and knee strength, movement patterns, tissue tolerance to load, and patellofemoral joint structure/function 1
- Individualized knee-targeted exercise therapy, with or without hip exercises, delivered following a robust assessment of symptom severity and irritability, and modified accordingly 1
- Education to underpin all interventions, providing a rationale for the delivery of a specific intervention plan, building confidence and understanding of the diagnosis, and promoting autonomy and reducing fear 1
- Supporting approaches, such as prefabricated foot orthoses, taping, and manual therapy, considered when rehabilitation and/or quality of life is hindered by elevated symptom severity and irritability, or high fear of movement 1
It is essential to differentiate bipartite patella from other conditions, such as patellar tendinopathy, which may present with similar symptoms but requires distinct management approaches, including eccentric exercise, deep transverse friction massage, and corticosteroid iontophoresis 1. By prioritizing conservative management and individualized treatment, clinicians can effectively address the unique needs of patients with bipartite patella and improve outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Definition and Prevalence
- A bipartite patella is an anatomical variant of the patella, where it is divided into two separate parts [ 2 ].
- This condition is relatively rare, affecting approximately 1-2% of the population [ 2 ].
Symptoms and Causes
- A bipartite patella is usually asymptomatic, but it can become a source of anterior knee pain after injury or overuse during sports [ 2 ].
- The pain is often enhanced by strenuous sports activity [ 2 ].
- The condition can also be caused by trauma or overuse, leading to cartilage edema and pain [ 2 ].
Treatment Options
- Conservative treatment, including physical therapy, extracorporeal shock wave therapy (ESWT), and viscosupplementation, can be effective in managing symptoms [ 2 ].
- Surgical intervention, such as excision of the fragment, screw fixation, synchondrosis drilling, lateral release, and arthroscopic or open interventions, may be necessary for refractory symptoms [ 3 ].
- Surgical techniques, such as excision of the painful fragment, can produce good results, with 91% of patients returning to sport without symptoms [ 4 ].
- Lateral retinacular release and detachment of the vastus lateralis muscle insertion are other surgical options that can produce good pain relief and union [ 5 ].
Outcomes and Prognosis
- Conservative management can lead to full resolution of symptoms in 76% of patients [ 3 ].
- Surgical intervention can achieve relief of pain in 84.1% of patients, with 98.3% able to return to their preoperative activity levels [ 6 ].
- Most patients (90.79%) who underwent surgical intervention had partial or complete resolution of their symptoms [ 3 ].