Bipartite patella is usually an asymptomatic entity. In adults, the incidence is between 0.2% to 6% and only 2% of these is symptomatic. Bipartite patella may cause anterior knee pain, the gold standard treatment is conservative, and the surgical treatment is reserved when the conservative treatment fails. The authors present an atypical clinical presentation of bipartite patella. Because this is a clinical entity that is often underdiagnosed, the subject in question is of paramount importance. The orthopedic community should include this entity in the differential diagnosis of anterior knee pain, and it is important to define guidelines for its diagnosis and treatment.
ResumoOs autores apresentam um caso de um fibroma da bainha de tendão com localização intra-articular no joelho e origem na gordura infrapatelar. Esta localização específica é extremamente rara, sendo este o quarto caso descrito de uma entidade que raramente afeta grandes articulações. Para o seu diagnóstico aspetos clínicos, epidemiológicos e sobretudo achados imagiológicos da ressonância magnética são fundamentais. Neste caso o diagnóstico definitvo foi apenas estabelecido após estudo histológico da massa excisada por mini-artrotomia.
Aim This study aims to evaluate functional and esthetic outcomes of thumb duplication correction in pediatric age. Methods Retrospective study including all pediatric patients with thumb duplication undergoing surgical treatment between 2012 and 2017. We analyzed demographic data, surgical technique, and surgical outcomes considering Tada, Horii, and Tien scores, according to the following parameters: active mobility of the metacarpophalangeal and interphalangeal joints, stability, alignment, and family’s opinion about cosmetic and function of the thumb. The Wassel-Flatt classification was used to classify the duplicated thumbs. Results A total of 11 patients were included, predominantly male (ratio 1.8:1), with a median age at time of surgery of 19[10-26] months and a median follow-up time after surgery of 23 [3-63] months. The Wassel- Flatt type IV thumb was the most frequent (73%). The postoperative evaluation revealed that 82% of patients had good results in Tada score, 73% had good results in Horii score, and all patients showed good results in Tien score. We found a relation between lower age and fair postoperative alignment ( P = .047) and between fair postoperative alignment and fair final Tada ( P = .022), Horii ( P = .006), and Tien ( P = .009) scores. Conclusions Excision and reconstruction procedures are good options in the treatment of thumb duplication providing good clinical results, with excellent parent satisfaction. Timing of surgery is important for favorable esthetic outcomes, while angular deformity is a determining factor that for postoperative dissatisfaction.
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