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Patella Bipartita

Authors:
Omer Ozkan at Dr. Ersin Arslan Training and Research Hospital
Omer Ozkan
  • Dr. Ersin Arslan Training and Research Hospital
Gurhan Donmez at Hacettepe University
Gurhan Donmez
Melda Pelin Yargic at Ankara Medipol University
Melda Pelin Yargic
  • Ankara Medipol University
Mahmut nedim Doral at Hacettepe University (Former instructor)
Mahmut nedim Doral
  • Hacettepe University (Former instructor)
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Abstract

Bipartite patella also known as patella bipartite, is a condition that is usually an asymptomatic and incidental finding of patella. Nevertheless, it can be a cause of anterior knee pain following acut trauma or a result of overuse or strenuous sports activity seen generally in adolesant patients. The usual treatment for symptomatic bipartite patella is to avoid painful activities. Most patients recover with nonsurgical treatment. Surgery should be considered when only nonsurgical treatment fails. Excision of the fragment is the most preferred surgical option which has good outcomes. Other surgical options are; lateral retinacular release, detachment of the vastus lateralis muscle and internal fixation of the separated fragment. Understanding the possible consequences of different treatment approaches to painful bipartite patella is necessary to preserve quadriceps muscle strength and patellofemoral joint function.
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Makale&Geliş&Tarihi:!21!Nisan!2017!Makale&Kabul&Tarihi:!2!Mayıs!2017!
Yazışma&Adresi:&Gürhan!Dönmez,!Hacettepe!Üniversitesi,!Spor!Hekimliği!Ad,!Ankara,!Turkey!
e8posta:!gurhan.donmez@hacettepe.edu.tr!
©2016&Türkiye&Spor&Hekimleri&Derneği&Tüm&hakları&saklıdır.&
!
Derleme&
! Spor!Hekimliği!Dergisi!51:(4)!128K134,!2016!
Turkish&Journal&of&Sports&Medicine&
DOI:&10.5152/tjsm.2016.015&
&
Patella&Bipartita&
!
Ömer!Özkan1,!Gürhan!Dönmez1,!Melda!Pelin!Yargıç1,!Mahmut!Nedim!Doral2!
1Hacettepe Üniversitesi, Spor Hekimliği Ad, Ankara, Turkey
2Hacettepe Üniversitesi, Ortopedi Ve Travmatoloji Ad, Ankara, Turkey
ÖZ&
Bipartite!patella!–!patella!bipartita!olarak!da!bilinen,!genellikle!patellanın!insidental!ve!
asemptomatik!saptanan!bir!bulgusudur.!Buna!rağmen,!genellikle!adolesan!hastalarda!olmak!
üzere!tekrarlayan!spor!aktivitelerini!takiben!ya!da!akut!travma!sonrası!ön!diz!ağrısı!ortaya!
çıkabilir.!Semptomatik!hastalarda!tedavinin!en!önemli!basamağı!ağrı!yaratan!aktivitelerden!
kaçınmaktır.!Çoğu!hastada!konservatif!yaklaşımla!sonuç!alınır.!Cerrahi!tedavi!yalnızca!
konservatif!yaklaşımdan!sonuç!alınamazsa!düşünülmelidir.!Aksesuar!fragmanın!eksizyonu!en!
çok!tercih!edilen!cerrahi!yöntem!olup!oldukça!iyi!sonuçlar!bildirilmiştir.!Diğer!cerrahi!
seçenekler;!lateral!retinakuler!gevşetme,!vastus!lateralis!kası!gevşetmesi!ve!ayrılmış!
fragmanın!internal!fiksasyonudur.!Ağrılı!bipartite!patellada!farklı!tedavi!yaklaşımlarının!olası!
sonuçlarını!anlamak!için;!patellofemoral!eklem!fonksiyonunu!ve!kuadriceps!kas!gücünü!
korumak!gereklidir.!
Anahtar&sözcükler:!Patella,!aksesuar!kemik,!varyasyon!
!
Patella&Bipartita&
ABSTRACT&
Bipartite!patella!also!known!as!patella!bipartite,!is!a!condition!that!is!usually!an!
asymptomatic!and!incidental!finding!of!patella.!Nevertheless,!it!can!be!a!cause!of!anterior!
knee!pain!following!acut!trauma!or!a!result!of!overuse!or!strenuous!sports!activity!seen!
generally!in!adolesant!patients.!The!usual!treatment!for!symptomatic!bipartite!patella!is!to!
avoid!painful!activities.!Most!patients!recover!with!nonsurgical!treatment.!Surgery!should!be!
considered!when!only!nonsurgical!treatment!fails.!Excision!of!the!fragment!is!the!most!
preferred!surgical!option!which!has!good!outcomes.!Other!surgical!options!are;!lateral!
retinacular!release,!detachment!of!the!vastus!lateralis!muscle!and!internal!fixation!of!the!
separated!fragment.!Understanding!the!possible!consequences!of!different!treatment!
approaches!to!painful!bipartite!patella!is!necessary!to!preserve!quadriceps!muscle!strength!
and!patellofemoral!joint!function.!
Key&words:!Patellae,!accessory!ossicle,!variation!
!
!
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An Unusual Case of Bipartite Patella Fracture with Quadriceps Rupture
Article
Full-text available
  • Aug 2006
Bipartite patella fracture with quadriceps rupture is an unusual injury. It is quite often mistaken as an avulsion fracture of patella, and the X-ray of contra-lateral knee is useful for diagnosis, and appropriate treatment should be decided at the time of surgery. We report a single case of this entity in which bipartite patella fracture was misdiagnosed initially as a patellar fracture.
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Ultrasonography: An imaging modality enabling the diagnosis of bipartite patella
Article
  • Jul 2001
Ultrasound was used to diagnose bipartite patella in seven adolescents with anterior knee pain, and the findings were compared to those from plain radiography and to those of a group of asymptomatic subjects. In all affected individuals the quadriceps and patellar tendons appeared normal on ultrasound. Sonographic examination of the patella demonstrated an irregularity of the bony contour with occurrence of a cleft between the main part of the patellar body and the large superolateral accessory ossicle. The signal detected in the interface between bones was less echogenic than bone reflecting its fibrocartilaginous nature. The correlation with conventional radiography was absolute, as was the inter- and intraobserver reliability. Ultrasound is thus proposed as a simple and reliable imaging modality in bipartite patella. We do not believe that it should replace the initial radiographic, but it can be used to evaluate the contralateral knee for bilaterality and as an adjunct to therapeutic procedures such as local injections to increase the accuracy of treatment.
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PrimÄre Knochenmarkseiterung der Kniescheibe
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  • Jan 1943
Es wird eine weitere Beobachtung einer der sehr seltenen primÄren Knochenmarkseiterungen der Kniescheibe mitgeteilt. Die mit den bisherigen FÄllen übereinstimmenden und von diesen abweichenden Besonderheiten derselben werden beschrieben.
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Patella fracture in a boy with bilateral inferior pole bipartite patellae
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  • Mar 2012
We present the case of a 12 year old boy who had bilateral inferior pole fragment (Saupe type 1) bipartite patellae, and who sustained a traumatic separation through the right patella while playing basket ball, the left remaining asymptomatic. We have reviewed and discussed the previously published literature and case reports.
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Arthroscopic treatment of symptomatic bipartite patella
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  • KNEE SURG SPORT TR A
Successful arthroscopic treatment of symptomatic bipartite patella in a 23-year-old female professional volleyball player is reported.
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Magnetic resonance imaging features of asymptomatic bipartite patella
Article
  • Nov 2009
The purpose of our study was to describe the magnetic resonance imaging (MRI) features of bipartite patella in asymptomatic patients. The study was prospective in type and performed following institutional ethical committees approval. In total, 25 subjects were recruited into the study and informed consent obtained in each case. The local radiology database was utilised in conjunction with a clinical questionnaire to identify patients who had asymptomatic bipartite patella. Any patient with a history of trauma or symptomatic disease was excluded from the study. MRI imaging was performed in each case on a 1.5 T system using a dedicated knee coil and a standardised knee protocol. The images obtained were then analysed by two musculoskeletal radiologists in consensus. Of the 25 subjects, there were 8 females and 17 males. The mean age was 34.6 years. All but one of the bipartite fragments were located on the superolateral aspect of the patella. In 23 cases, one fragment was identified. The average transverse diameter of the fragment was 12.8 mm. The average distance between the fragment and the adjacent patella in the axial plane was 1.46 mm. In addition, the cartilage overlying the patella and accessory fragment was intact in all cases. The average thickness of the patella cartilage at its border to the fragment was 2.4mm with an average ratio of the cartilage thickness of the fragment as compared with the cartilage thickness of the patella of 0.72. There was no evidence of high signal or bone marrow oedema on fluid sensitive sequences within either the patella or the fragment in any of the patients. Fluid was identified in the cleft between the patella and the fragment in the majority of cases. Asymptomatic bipartite patella is characterised by intact but thinned cartilage along the border between the patella and the fragment, fluid between the cleft and a lack of any bone marrow oedema or high signal within the patella or its fragment.
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Bipartite Patella in a Young Athlete
Article
  • Feb 2009
The patient was a 12-year-old male with a chief complaint of right anterior knee pain for the past 3 months. The patient was referred to physical therapy by an orthopaedic surgeon with a diagnosis of patellofemoral pain and bipartite patella. The patient was advised to avoid painful activities and a quadriceps-strengthening program was initiated. At the time of discharge, the patient had normal quadriceps strength and pain-free knee range of motion. Often an asymptomatic and incidental finding, bipartite patella results when secondary ossification centers do not fuse to form a single bone. Treatment typically entails rest and conservative management; however, in individuals with persistent symptoms that are not responsive to conservative measures, surgical intervention may be necessary.J Orthop Sports Phys Ther 2009;39(7):560. doi:10.2519/jospt.2009.0407.
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Arthroscopic Removal of Separated Bipartite Patella Causing Snapping Knee Syndrome
Article
  • Aug 2008
The bipartite patella is a developmental osseous variant that is found in approximately 2% to 6% of the population, and is bilateral in 50%. The proposed etiologies include old nonunion, osteochondritis, and congenital growth defect. It is often found incidentally around the inferior pole, lateral margin, or superolateral border of the patella. It is usually asymptomatic, but may be related to anterior knee pain. However, separation of the bipartite patella is rare, with 9 cases reported in the literature. The symptomatic snapping knee syndrome may be caused by multiple intra-articular and extra-articular pathology including discoid meniscus, tumors, iliotibial band, popliteus, gracilis, semitendinosus, or biceps femoris tendon. However, no reports exist on separated bipartite patella as the feasible cause of the snapping knee syndrome in the orthopedic literature. This article presents a case of snapping knee syndrome due to separated bipartite patella. The accessory bone was removed by arthroscopy, which has rarely been described in the literature.
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Symptomatic Bipartite Patella: Treatment Alternatives
Article
  • Sep 2008
Bipartite patella is usually an asymptomatic, incidental finding. However, in adolescents, it may be a cause of anterior knee pain following trauma or a result of overuse or strenuous sports activity. Most patients improve with nonsurgical treatment. Surgery is considered when nonsurgical treatment fails. Excision of the fragment is the most popular surgical option, with good results. However, when the fragment is large and has an articular surface, excision may lead to patellofemoral incongruity. Lateral retinacular release and detachment of the vastus lateralis muscle insertion are other surgical options and are reported to produce good pain relief and union in some patients. These procedures reduce the traction force of the vastus lateralis on the loose fragment. Internal fixation of the separated fragment has limited support in the literature. Understanding the possible consequences of different treatment approaches to painful bipartite patella is necessary to preserve quadriceps muscle strength and patellofemoral joint function.
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