Bipartite Patella Research Articles

Ultrasound-guided injection and the pie crust technique for the treatment of symptomatic bipartite patella.

This study aimed to investigate the results of a new treatment procedure (ultrasound-guided injection and the "pie crust" technique for lengthening of capsular tendon structures) for symptomatic bipartite patella. We retrospectively investigated patient outcomes following the treatment of symptomatic type III bipartite patella with our new technique. Fifteen knees in 14 boys (mean age, 13.0 ± 1.7years) were included. The procedure involved the injection of 1% lidocaine (2mL) and triamcinolone acetonide (5mg) between the patella and fragment. We then punctured 10 sites from one skin puncture to extend lateral capsular tendon structures. The patients were clinically assessed using the Victorian Institute of Sports Assessment (VISA) score before and 1week, 1month, and 3months after the procedure. Patients were also evaluated for complications. The average VISA score was 45.7 ± 4.7 before treatment, 70.6 ± 7.3 at 1week post-treatment, 84.4 ± 16.6 at 1month post-treatment, and 88.6 ± 18.3 at 3months post-treatment. The VISA score improvement from before the procedure to 1week after the procedure was significant (P < 0.01). There were no complications in any of the patients, who returned to sports at a mean of 4.2 ± 2.1weeks after the procedure. However, two patients (three knees) had poor results and could not return to action; thus, they underwent surgical treatment 4months after the ultrasonographic procedure. This novel method is a potential treatment option for the management of symptomatic bipartite patella in outpatient clinics.

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

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.

Epidemiology of Existing Extensor Mechanism Pathology in Primary Anterior Cruciate Ligament Ruptures in an Active-Duty Population.

The purpose of this study is to determine the prevalence of potential graft-influencing pathologies of the extensor mechanism of the knee in patients presenting with a primary anterior cruciate ligament (ACL) rupture. We performed a retrospective review of the plain radiographs and magnetic resonance imaging (MRI) of all active-duty patients presenting with a primary ACL rupture at our institution between July 2006 and February 2009. Imaging was reviewed to determine the presence of a multipartite patella, unresolved Osgood-Schlatter's disease, and/or radiographic evidence suggestive of patella tendinopathy. A total of 197 patients were reviewed, including 27 females and 170 males. One patient (0.5%) had a bipartite patella and 4 patients (2%) had free-floating ossicles about the tibial tuberosity consistent with unresolved Osgood-Schlatter's disease. A total of 15 patients (7.6%) showed MRI evidence suggestive of patella tendinopathy. This study revealed 20 patients out of 197 (10.1%) who presented with existing extensor mechanism pathologies in radiologic studies. While preoperative imaging is routinely used to confirm clinical suspicion of ACL rupture or identify associated injuries, this study shows that it can also identify existing extensor mechanism pathologies that could ultimately influence the use of an extensor mechanism graft.

Role of Magnetic Resonance Imaging in Evaluation of Anterior Knee Pain

Background: the term “anterior knee pain” is often used interchangeably with “Patellofemoral pain syndrome PFPS” or “runner’s knee”. PFPS can be defined as anterior knee pain involving the patella and retinaculum. Aim of the Work: to highlight the role of magnetic resonance imaging (MRI) in the diagnosis and grading of the most common causes of anterior knee pain. Patients and Methods: this study included fifty patients, their ages range between 10-60 years (average age 27 years). All presented with anterior knee pain (AKP) and were referred to the Radiology Department of El-Demerdash Hospital for MRI examination after orthopedic consultation.Results: the role of MRI in the diagnosis and grading of the most common causes of anterior knee pain have been shown in this study. These causes have been classified in to five disease categories; Patellar abnormalities represented most of them (64% of the sample size) and they included chondromalacia patella, patellar instability, transient patellar dislocation and painful bipartite patella. Hoffa’s diseases represented 12% of the sample size and they included Hoffa impingement syndrome and Hoffa fibrotic bands. Patellar tendon disorders represented 6 % of the sample size and they included Patellar Tendinopathy and Osgood Schlatter Disease. Quadriceps tendon disorders represented 4% of the sample size and they included Quadriceps Tendinopathy. Other causes represented 14% of the sample size and they included torn anterior horn of the lateral meniscus and cartilage injuries. Conclusion: many factors may cause anterior knee pain. MRI is generally safe, non-ionizing, non-invasive and valuable imaging technique which has been proven to be the modality of choice for establishing an accurate diagnosis of different knee pathologies that cause anterior knee pain in different age groups. It also allows to know the extent, severity, grades and types of the lesions, what will be necessary to decide appropriate treatment. Recommendations: further studies on a larger scale of patients are needed to confirm the results obtained by this work.

Clinical Outcome of Arthroscopic Lateral Retinacular Release for Symptomatic Bipartite Patella in Athletes

To report the results of arthroscopic lateral retinacular release without excision of the accessory fragment for treatment of symptomatic bipartite patella with a minimum 2-year follow-up. We retrospectively reviewed all cases of symptomatic type III bipartite patella confirmed by radiographs, computed tomography, and magnetic resonance imaging and treated with arthroscopic lateral release from 2005 to 2015. Patients with history of knee fractures or surgery, concomitant meniscal or anterior cruciate ligament (ACL) procedures, and severe arthritic changes of the patellofemoral joint were excluded. Patients were assessed by Kujala score, visual analog scale (VAS), Tegner Activity Scale (TAS), and time to return to sporting activities. Ten patients (11 knees) were clinically reassessed after 69.6 ± 33.3 (range: 25-132; 95% confidence interval [CI]: 47.29-91.99) months from surgery. There was a significant improvement in Kujala (P < .05) and VAS scores (P < .05), and no differences were found between pre- and postoperative TAS scores (P > .05). No complications occurred during the follow-up period. All patients returned to sport after 42.3 ± 11.3 (range: 30-60; 95% CI: 34.71-49.84) days after surgery. The arthroscopic lateral retinacular release of a symptomatic type III bipartite patella without excision of the accessory fragment allowed early return to sporting activities, with excellent symptom relief. Patients had significantly improved mean Kujala and VAS scores without a decrease in the mean TAS scores. Level IV, case series.

Clinical, morphologic, and demographic characteristics of bipartite patella in patients referred to Iranian academic clinics

In a descriptive cross-sectional study, we evaluated clinical, morphologic, and demographic characteristics of bipartite patella (BP) in 20 patients referred to clinics affiliated to Iran University of Medical Sciences from 2011 to 2015. Simple radiography, computerized topography scanning, and magnetic resonance imaging characteristics of BP plus demographic data include age, gender, co-morbidities, and side of involvement were recorded. Male to female ratio was 17:3 (5.6) with total mean age of 39.1 ± 13.4 years. Sixteen patients (80%) had unilateral involvement, and among them right- and left-side involvements were seen in 11 and 5 patients, respectively. The BP position included superolateral (8 patients, 40%), lateral (5 patients, 25%), and inferomedial (7 patients, 35%). Knee pain, joint stiffness, and decrease the motion range were seen in 13 (65%), 7 (35%), and 11 (55%) patients, respectively. Chondromalacia (7 patients, 35%) and bone marrow edema (7 patients, 35%) were the most common co-morbidities. The mean diameter of the cartilage that covered the segment in right and left sides were 8.92 ± 3.63 and 9.01 ± 2.22 mm, respectively (P > 0.05). The right and left sides distance of segment to patella were 2.50 ± 0.86 and 3.17 ± 1.45 mm, respectively (P > 0.05). No significant associations were detected between age, gender, decrease the motion range, pain, and joint stiffness with sides of involvement (P > 0.05). Just patients with bone marrow edema had significant higher diameter of cartilage that covered the segment in comparison to patients without bone marrow edema (P = 0.010). In summary, higher percentage of male, existence of pain, and decrease the motion range plus superolateral position of the bipartite segment were noticeable which must be considered in the future research.

Arthroscopic Bony Resection for Treatment of Symptomatic Bipartite Patella

Bipartite patella is a common pathology, affecting 2% to 3% of the population. Usually these cases are bilateral and asymptomatic. However, a patient with a bipartite patella may complain of pain, which is most likely related to fragment mobility. Conservative treatment with physiotherapy, immobilization, and nonsteroidal drugs are encouraged during the initial 6 months following diagnosis. This option is effective in most patients. For patients who do not improve with these conservative measures, surgical intervention is indicated. Many surgical treatment options have been described including excision of the fragment, as well as fixation. Fragment excision has demonstrated positive outcomes and is associated with an asymptomatic return to sport activities. The purpose of this Technical Note is to describe our preferred arthroscopic technique for the treatment of symptomatic bipartite patella.

Evaluation and management of knee pain in young athletes: overuse injuries of the knee.

Recurrent or chronic activity related knee pain is common in young athletes. Numerous intrinsic conditions affecting the knee can cause such pain. In addition, knee pain can be referred pain from low back, hip or pelvic pathology. The most common cause of knee pain in young athletes is patellofemoral pain syndrome, or more appropriately termed idiopathic anterior knee pain. Although, numerous anatomical and biomechanical factors have been postulated to contribute the knee pain in young athletes, the most common underlying reason is overuse injury. In this paper, we have reviewed selected conditions that case knee pain in athletes, including anterior knee pain syndrome, Osgood-Schlatter disease, Sinding-Larsen-Johanssen syndrome, juvenile osteochondritis dissecans (JOCD), bipartite patella, plica syndrome, and tendonitis around the knee.

Surgical Technique for Arthroscopic Resection of Painful Bipartite Patella

Bipartite patella (BP) is uncommon and is usually an incidental finding. Painful BP occurs rarely and is usually associated with post-traumatic anterior knee pain. When nonoperative treatment fails, fragment resection is indicated. A systematic review shows a potentially increased risk of complications with open surgery. The purpose of this Technical Note is to demonstrate a simple arthroscopic technique for treating painful BP through resection of the bone fragment.

Successful Treatment of Painful Synchondrosis of Bipartite Patella after Direct Trauma by Operative Fixation: A Series of Six Cases.

Introduction:The patella is the largest sesamoid bone in the body and may have one (77%) or multiple (23%) ossification centres. Patellar and patellofemoral joint abnormalities are a common cause of anterior knee pain but symptomatic bipartite patella is an uncommon problem.Case Series:We report a series of six cases of painful synchondrosis in bipartite patellae, all in keen athletes following a direct blow to the anterior aspect of the knee. A complete rupture of the synchondrosis with evidence of retropatellar chondral separation was seen on MRI scan in all cases. Successful surgical fixation was undertaken with complete resolution of symptoms in all patients at an average of three months post-operatively.Conclusion:Painful synchondrosis of a bipartite patella in young and active individuals following direct trauma is a relatively rare cause of anterior knee pain, but may be associated with significant morbidity. In cases refractory to non-operative management, successful symptomatic treatment can be achieved by operative fixation.

Patella Bipartita

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.

Treatment of Symptomatic Bipartite Patella by Fragment Excision, Capsular Repair and Novel ITB Release

Objectives:The aim of this paper is to present the mid-term results of a novel technique used to treat symptomatic bipartite patella.Methods:Diagnosis of symptomatic bipartite patella was made by history, examination, Xray, MRI and/or bone scan. Patients with typical localised pain, pain on manually stressing the fragment, a positive ITB tightness test, a typical Xray and either, a hot bone scan or bone oedema on MRI were considered for treatment. All patients had a pre-op Kujala and Lysholm score recorded.Surgical Technique:Under GA and tourniquet a 4 part procedure was performed: Routine arthroscopy to assess patella tracking and fragment stabilityA 2 cm incision was made on the distal thigh 10-12 cm above the joint line over the ITB. A zig-zag incision was made across the ITB/IPB from anteriorly to the corner of the intermuscular septum.A 4 cm incision was made over the edge of the lateral patella. A longitudinal capsular incision was made at the edge of the patella. The capsule was reflected off the dorsal patella by sharp dissection and the bipartite fragment was excised through the synchondrosis.A watertight repair of the lateral capsule was performed with absorbable suture. Routine closures were performed.Comment:The author considers the ITB/IPB to be an important factor in the development and progression of the disorder. The addition of the novel release allows a tension-free capsular repair, reducing lateral facet loads, improving patella tracking without affecting patella stabilityResults:Over an 11 year period twenty patients underwent the procedure. 15 were available with a minimum 2 year and mean 6.35 year follow-up. Pre-op and post-op Kujala and Lysholm scores were compared. Patients were predominantly male (14:1) between ages 10-54 years. A clear history of trauma was present in 6 patients while in 9 symptoms were related to overuse. The pre-op Kujala score ranged from 28-90 with an average of 59. Post-op scores improved markedly with range 70-100 with 12 patients (80%) scoring >90 and an average improvement of 32 pts. Lysholm scores similarly improved significantly, with an average 32 pts improvement (range 1-66). Complications were minimal.Conclusion:Fragment excision, capsular repair and novel ITB release resulted in significant reproducible improvements in both objective and subjective outcome measures. Resolution of symptoms occurred in all patients suggesting the technique is a useful option in the treatment of symptomatic bipartite patella.

Forensic Identification of Bipartite Patella Misdiagnosed as Patella Fracture

Bipartite patella is recognized as a developmental anomaly of ossification. Most of them are asymptomatic and are discovered incidentally. Bipartite patella is sometimes misdiagnosed as a patella fracture, because the x-ray images of both these conditions may appear very similar. In this case, the patient complained of left knee pain after x-ray films revealed a fracture-like line in the left patella. The patient was then diagnosed as having a patella fracture. In China, the injury degree is categorized as serious injury, minor injury, and trivial injury. As the injury degree of patellar fracture is identified as minor injury, the defendant who injured the patient will be sentenced to prison for ≤3 years. However, the defendant objected to this judgment and applied for the second evaluation of injury degree. On the basis of the site of injury, clinical manifestations, and imaging findings, we diagnosed the patient with bipartite patella which belongs to normal anatomic variant. Therefore, the injury degree of the patient was not minor injury.

Bipartite patella associated with tophaceous invasion: A rare case report

We report the case of 32-year-old male who had a painful knee due to tophus formation in the interosseous area of the bipartite patella. There was neither a history of previous trauma to his patella nor a family history of gouty arthritis. Intraoperatively, we found chalky white-yellow material deposited at the bipartite space and it was curetted. The second part of the patella was fixed by a screw for functional preservation. In addition, hyperuricemia was also noted and controlled by uricosuric agents postoperatively. Gout should be included in the differential diagnosis of painful bipartite patella, and we suggest surgical intervention in combination with antihyperuricemic therapy for tophaceous deposits of the bipartite patella.

Application of kinesiotaping to treat symptomatic bipartite patella

Application of kinesiotaping to treat symptomatic bipartite patella

Patellar malalignment: a new method on knee MRI.

PurposeThe medial patellofemoral ligament (MPFLL)/lateral patellar retinaculum (LPR) ratio were assessed in knees as a means to detect patellar malalignment. We also aimed to evaluate the prevalence of the various types of trochlear dysplasia in patients with patellar malalignment.Materials and methodsAfter approval of our institutional ethics committee, we conducted a retrospective study that included 450 consecutive patients to evaluate them for the presence of patellar malalignment. Parameters investigated were the trochlear type, sulcus angle, presence of a supratrochlear spur, MPFLL, LPR, patella alta, and patella baja by means of 1.5T magnetic resonance imaging (MRI). Overall, 133 patients were excluded because of the presence of major trauma, multiple ligament injuries, bipartite patella, and/or previous knee surgery. The Dejour classification was used to assess trochlear dysplasia. Two experienced radiologists (HKY, EEE) evaluated the images. Their concordance was assessed using the kappa (κ) test.ResultsThe frequencies of patellar malalignment and trochlear dysplasia were 34.7 and 63.7 %, respectively. The frequency of trochlear dysplasia associated with patellar malalignment was 97.2 %. An MPFLL/LPR ratio of 1.033–1.041 had high sensitivity and specificity for malalignment. The researchers’ concordance was good (κ = 0.89, SE = 0.034, P < 0.001).ConclusionTrochlear dysplasia is frequently associated with patellar malalignment. An increased MPFLL/LPR ratio is useful for detecting patellar malalignment on knee MRI, which is a novel quantitative method based on ligament length.

Several Infra‐cranial Non‐metric Variations in a Single Neolithic individual: A Common Genetic Underlying Predisposition?

AbstractNon‐metric variations have been the subject of anatomical and anthropological studies for more than a century. In this study, we present an individual from Sion (Canton of Valais, Southern Switzerland) dated from the Middle Neolithic who shows evidence for four non‐metric variations. This young adult male presents an os acromiale, spondylolysis, a bipartite patella, and bilateral calcaneus secundarius. These non‐metric variations have a low frequency in most populations (less than 10%), and for each of them the origin is usually considered to be genetic, environmental, or a combination of both. This case is of interest for understanding the potential genetic origin of these non‐metric variations as well as for demonstrating their usefulness in bioarcheological analysis. Copyright © 2016 John Wiley &amp; Sons, Ltd.

A symptomatic cyst originating from a bipartite patella

A symptomatic cyst originating from a bipartite patella

Unique patellofemoral alignment in a patient with a symptomatic bipartite patella

BackgroundA symptomatic bipartite patella is rarely seen in athletic adolescents or young adults in daily clinical practice. To date, only a limited number of studies have focused on patellofemoral alignment. The current study revealed a unique patellofemoral alignment in a patient with a symptomatic bipartite patella. MethodsTwelve patients with 12 symptomatic bipartite patellae who underwent arthroscopic vastus lateralis release (VLR) were investigated (10 males and two females, age: 15.7±4.4years). The radiographic data of contralateral intact and affected knees were reviewed retrospectively. From the lateral- and skyline-view imaging, the following parameters were measured: the congruence angle (CA), the lateral patellofemoral angle (LPA), and the Caton–Deschamps index (CDI). As an additional parameter, the bipartite fragment angle (BFA) was evaluated against the main part of the patella in the skyline view. ResultsCompared with the contralateral side, the affected patellae were significantly medialized and laterally tilted (CA: P=0.019; LPA: P=0.016), although there was no significant difference in CDI (P=0.877). This patellar malalignment was found to significantly change after VLR (CA: P=0.001; LPA: P=0.003) and the patellar height was significantly lower than in the preoperative condition (P=0.016). In addition, the BFA significantly shifted to a higher degree after operation (P=0.001). ConclusionsPatients with symptomatic bipartite patellae presented significantly medialized and laterally tilted patellae compared with the contralateral intact side. This malalignment was corrected by VLR, and the alignment of the bipartite fragment was also significantly changed.Level of evidence: Level IV, case series

Management of bipartite patella – A review of 5 cases

Management of bipartite patella – A review of 5 cases