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Symptomatic Bipartite Patella: Treatment Alternatives

Dr. Atesok is Orthopaedic Surgeon and Research Assistant, St. Michael’s Hospital Musculoskeletal Research Lab, Toronto, Ontario, Canada. Dr. Doral is Consultant Orthopaedic Surgeon, and Professor and Chairman, Department of Sports Medicine, Hacettepe University Medical School, Ankara, Turkey. Dr. Lowe is Consultant Orthopaedic Surgeon and Head, Arthroscopy and Sport Injury Unit, Department of Orthopaedics, The Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Dr. Finsterbush is Professor Emeritus, Arthroscopy and Sport Injury Unit, Department of Orthopaedics, The Hadassah-Hebrew University Medical Center.

None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Atesok, Dr. Doral, Dr. Lowe, and Dr. Finsterbush.

Reprint requests: Dr. Atesok, St. Michael’s Hospital Musculoskeletal Research Lab, 30 Bond Street, Shuter Wing 5-076, Toronto, Ontario, Canada M5B 1W8.

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.