Unique patellofemoral alignment in a patient with a symptomatic bipartite patella

Ishikawa, Masakazu; Adachi, Nobuo; Deie, Masataka; Nakamae, Atsuo; Nakasa, Tomoyuki; Kamei, Goki; Takazawa, Kobun; Ochi, Mitsuo

doi:10.1016/j.knee.2015.04.009

Cited by 9 publications

(6 citation statements)

References 31 publications

(36 reference statements)

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“…Weckström et al reported symptomatic patients who had undergone surgery for excision of a painful fragment; the median age at the time of surgery was 20 years [17]. Also, Ishikawa et al reported the mean age of the patients with symptomatic bipartite patella as 15.7 ± 4.4 years [20]. Although these published reports defined patients with young age with symptomatic bipartite patella, our study is the first in the literature to identify statistical differences between age groups and symptomatology.…”

Section: Discussionmentioning

confidence: 64%

Magnetic resonance imaging for diagnosis of bipartite patella: usefulness and relationship with symptoms

et al. 2019

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PurposeBipartite patella is a rare developmental variation of the knee cap. We aimed to identify the magnetic resonance imaging (MRI) features of bipartite patella and evaluate the association with clinical symptoms.Material and methodsMRI exams of 61 patients with bipartite variant were evaluated for types of bipartite patella, oedema around the synchondrosis, bipartite fragment height (FH), distance between the fragment and the patella (FPD), and signal characteristics within the synchondrosis. The study was designed with two observers in order to achieve intra- and interobserver compliance. Any other major knee pathologies that can cause pain were also recorded.ResultsOf the 61 participants the average age was 40.1 ± 14.3 years, 44 were males, and 17 were females. Fifty-nine of the bipartite fragments were located at the superolateral quadrant of the patella. There was oedema at the bipartite area in 35 patients. Ten of these patients had no major MRI diagnosis other than oedema, and they were classified as the symptomatic group. The age of the patients in the symptomatic group was statistically lower than in the asymptomatic group (p < 0.05). There was no statistically significant difference between the groups in terms of male and female distributions, signal types across the synchondrosis, and FH or FPD measurements (p > 0.05). High concordance correlation coefficients were observed on measurementsConclusionsMRI of the knee is highly accurate in evaluation of bipartite patella. To our knowledge; a detailed MRI analysis, like in our study, has not previously been performed, and our report is unique in showing that the symptomatic occurrence of bipartite patella is statistically higher in young patients.

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Section: Discussionmentioning

confidence: 64%

Magnetic resonance imaging for diagnosis of bipartite patella: usefulness and relationship with symptoms

et al. 2019

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“…Open excision with resection of the accessory fragment is the most common procedure performed in athletes [17]. Lateral release may reduce excess lateral traction force, denervate the pain fibers to the fragment, improve the patellofemoral tracking and promote bony union [4,5, 18–20]. In the current study, open fragment excision with or without lateral release on six knees yielded a complete resolution of symptoms.…”

Section: Discussionmentioning

confidence: 62%

Outcomes of surgical treatment of symptomatic bipartite patella in teenage athletes

Pan

Hennrikus

2021

Journal of Pediatric Orthopaedics B

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Bipartite patella affects about 2% of people. Most cases are asymptomatic; however, some develop anterior knee pain during sports. When conservative treatment fails, surgery can be considered. This study reports the outcomes of fragment excision with or without lateral release in teenage athletes with symptomatic bipartite patella. The study was approved by the College of Medicine Institutional Review Board. A retrospective review was performed. Patients were excluded if age >18 or had prior knee surgery. Data collected included age, gender, BMI, sports played, Saupe classification, conservative and surgical treatment, advanced imaging used, duration of follow-up, Lysholm Score and postoperative complications. Five teenage patients were studied. The average age was 15.6 years and BMI was 23. Sports played included basketball, football, track-and-field and soccer. All patients complained of anterior knee pain exacerbated by sports. All patients failed >6 months of conservative treatment. Saupe classification included four type III (superolateral) and one type II (lateral). Two patients had an MRI. Surgical treatment included two open excisions and three arthroscopic-assisted open excisions with lateral releases. The average Lysholm Score was 97. Postoperatively, all patients returned to presurgery sporting activity at an average of 9.8 weeks (range, 6–13 weeks). A 16-year-old male treated by open excision developed a postoperative wound infection. He was successfully treated with irrigation & debridement and antibiotics and returned to sports at 6 weeks. Symptomatic bipartite patella is an uncommon cause of anterior knee pain in adolescent athletes. When pain persists despite conservative care, fragment excision with or without lateral release resulted in excellent pain relief and return to full sporting activity in all cases.

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“…On the other hand, an excessive traction force on the partite fragment by the lateral retinaculum and vastus lateralis with repeated flexion and extension generates abnormal stress on the synchondrosis or pseudarthrosis [ 1 9 ]. Moreover, a recent study reported the presence of patellofemoral malalignment, medialized and laterally tilted patella compared to the contralateral intact side, in symptomatic bipartite patella [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Unusual Symptomatic Multipartite Patella Associated with Quadriceps Fat Pad Edema

Özdemi̇r

Görmeli

Kahraman

et al. 2016

Journal of the Belgian Society of Radiology

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Partite patella is a known cause of anterior knee pain, especially in adolescents and young males, although most patients are asymptomatic. Symptomatic partite patella is usually revealed on magnetic resonance imaging (MRI) as bone marrow edema within the opposing bone fragments. We present a case of unusual bilateral symptomatic multipartite patella in an adult who presented with quadriceps fat pad edema and mass effect as well as slightly edematous signal changes within the bone fragments on MRI. This case indicates that symptomatic partite patella can also present with edema-like imaging findings in the adjacent soft tissue due to chronic mechanical irritation.

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Unique patellofemoral alignment in a patient with a symptomatic bipartite patella

Cited by 9 publications

References 31 publications

Magnetic resonance imaging for diagnosis of bipartite patella: usefulness and relationship with symptoms

Magnetic resonance imaging for diagnosis of bipartite patella: usefulness and relationship with symptoms

Outcomes of surgical treatment of symptomatic bipartite patella in teenage athletes

Unusual Symptomatic Multipartite Patella Associated with Quadriceps Fat Pad Edema

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