Painful Bipartite Patella Research Articles

Arthroscopic Management for Bipartite Patella: A Systematic Review.

Background:Bipartite patella is a rare congenital condition that becomes painful following direct trauma or an overuse injury. If it remains painful despite nonoperative treatment, surgery may be warranted. The current gold standard is open fragment excision or lateral release; however, arthroscopic management is also possible.Purpose:To investigate the safety and efficacy of arthroscopic treatment of painful bipartite patella.Study Design:Systematic review; Level of evidence, 4.Methods:Using Medline and Embase, we systematically reviewed the literature as of March 8, 2020, using the subject headings “bipartite patella” and “arthroscopy” and related key terms. All levels of evidence involving human studies in English were included. Articles were excluded if only the abstract was published or the study was related to nonsurgical treatment or nonrelated diagnoses. Data related to journal/article information, demographic/clinical data, arthroscopic technique, length of follow-up, treatment outcomes, and complications were extracted.Results:Eleven articles with 43 patients were included in the review. Most patients (n = 34; 79%) underwent arthroscopic lateral release, while 16% (n = 7) had arthroscopic excision of the accessory fragment and 5% (n = 2) had arthroscopic excision and release. All patients except for one, who experienced postoperative trauma, were pain-free after arthroscopic treatment and were able to return to sports after a mean 2.6 months.Conclusion:This review demonstrated that arthroscopic management of painful bipartite patella is a safe and effective alternative to open surgical excision or release. However, all articles were case studies or small case series, owing to the rarity of the condition. In the future, higher-level studies comparing arthroscopic techniques and postoperative rehabilitation programs should be performed.

Role of MRI in Evaluation of Anterior Knee Pain

Abstract Background: MRI is well known for being particularly useful for scanning and detecting abnormalities in soft tissue structures like the cartilage tissues, tendons, and ligaments. Moreover, MRI can also aid in determining those patients with knee injuries who will require surgical intervention. MR imaging is recognized as a standard procedure and has replaced diagnostic arthroscopy as the primary diagnostic modality for many knee pathologies. Furthermore, MR images can be used to assess anatomic variants that may contribute to chronic patellar instability. Aim of Study: To go over several of the most common causes of Anterior Knee Pain (AKP), with emphasis on their MRI findings with the goal of allowing diagnosis that is more accurate and grading of some of the most common pathologies, for interpreting, reaching an efficient treatment and drastic improvement of this common complaint. Patients and Methods: This study included 25 patients (8 females and 17 males). Their ages ranging between 10-60 years (average age 30 years). All presented by anterior knee pain and were referred to Radiology Department of Ain Shams University Hospital or private centers for MRI examination after orthopedic consultation. This descriptive study was done to detect the role of MRI in the evaluation of anterior knee pain and apply advanced MRI techniques such as sagittal T2 mapping to visualize the articular cartilage of the knee. Most patients were subjected to MR imaging of the affected knee joints on high field strength scanners using Philips scanners Achieva or Intera (1.5T). Results: The present study revealed that 26% patellar tendon disorders which included (patellar Tendinopathy 21% and Osgood Schlatter disease 5%). Quadriceps tendon disorders represented 10% and they are including (Quadriceps Tendin-opathy 5% and Quadriceps tendon tear 5%). 69% of the sample size showed Patellar disorders represent and they are including (chondromalacia patella 32%, patellar instability 21%, transient patellar dislocation 11% and painful bipartite patella 5%). Hoffa's disease was demonstrated in 21% of the sample size and they are including (Hoffa impingement syndrome and Hoffa ganglion cyst), finally we have torn anterior horn of the lateral meniscus and they represent 5%. Conclusion: MRI is generally safe, accurate, and specific modality, which has been proven to be the modality of choice in the diagnosis of different knee pathologies that cause anterior knee pain in different age groups. Also it has a high specification in detecting the grades and types of some of these diseases or factors predispose to them as patella Alta and trochlear dysplasia.

Arthroscopic Resection of Symptomatic Avulsioned Type III Bipartite Patella: A Case Report

Although Bipartite Patella is usually asymptomatic, it may become symptomatic after repeated traumas. The treatment of avulsed and painful bipartite patella consists conservative treatments including, rest and physiotherapy but surgical treatment can be required in inconclusive cases. Surgical treatment consists, open or arthroscopic excision of the painful fragment and release of the lateral retinaculum. In this case report, we present 19-yearold male patient who underwent arthroscopic resection of his type III avulsioned bipartite patella. While we were performing the arthroscopic surgery for the treatment, we minimized the problems related to open surgery.

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.

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.

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.

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.

The management of the painful bipartite patella: a systematic review.

This study aimed to identify the most effective method for the treatment of the symptomatic bipartite patella. A systematic review of the literature was completed, and all studies assessing the management of a bipartite patella were included. Owing to the paucity of randomised controlled trials, a narrative review of 22 studies was completed. A range of treatments were assessed: conservative measures, open and arthroscopic fixation or excision and soft tissue release and excision. All of the methods provided results ranging from good to excellent, with acceptable complication rates. This is a poorly answered treatment question. No firm guidance can be given as to the most appropriate method of treating the symptomatic bipartite patella. This study suggests that there are a number of effective treatments with acceptable complication rates and it may be that treatments that conserve the patella are more appropriate for larger fragments. IV.

Developmental anomaly of ossification type patella partita

Bipartite patella has been recognized as an incidental radiographic finding. However, symptomatic bipartite patella is occasionally diagnosed in adolescents and young athletes. The incidence of bipartite patella has been reported at 0.2-1.7, and 1-2% of these cases are symptomatic. The purpose of this review article was to discuss current concepts relevant to developmental anomaly of ossification type patella partita. A PubMed database search using the key words "bipartite patella" was performed. Clinical papers reporting the bipartite patella were included. Four German-language studies were also included, three for incidence of bipartite patella and one for classification. A new classification of developmental anomaly of ossification type patella partita based on location and number of fragment was recently proposed. It is simple and useful and applicable to all types of bipartite or tripartite patella. Several imaging studies have reportedly been used to evaluate symptomatic bipartite patella. MRI is currently the most appropriate method used to assess patients with bipartite patella. Although surgical procedures have been developed that reduce excessive traction force by the vastus lateralis muscle on the bipartite fragment, there is not sufficient evidence to support their use for routine treatment of painful bipartite patella. In most symptomatic cases, movement at the interface between the bipartite fragment and the body of the patella presumably causes the pain. Therefore, the existence of apparent motion at the interface should be confirmed by specific imaging studies before surgery. Magnetic resonance imaging findings may provide such evidence by demonstrating a fluid bright signal across the segmentation, typical of pseudoarthrosis. V.

A concern regarding the diagnosis of injury of a bipartite patella at the lower part of the patella

I read with interest the article by Stocker et al. [1] entitled “Injury of a bipartite patella in a young upcoming sportsman”. I congratulate the authors on their very interesting case report; however, I have a concern regarding their diagnosis. It is my opinion that this case was not an injury of a bipartite patella but probably a fracture or stress fracture of the lower part of the patella. Their case suVered an intense pain around his left knee-cap while taking oV from a jumping board. A light swelling and light hematoma as well as local pain were identiWed. X-rays and magnetic resonance imaging showed an isolated distal pole of the patella with 2 mm diastasis. The radiographs taken 10 weeks after the injury showed a complete consolidation. In that report, the authors stated that a fracture or separation of the bipartite patella was retrospectively diagnosed. However, in our previous histopathological studies of the painful bipartite patella, we found that the striking features of the interpose tissue were Wbrous tissue and necrosis of the Wbrocartilage [2]. Therefore, I suppose that in the case of the developmental anomaly of ossiWcation type bipartite patella, consolidation may not take place and when consolidation is shown, it is probably fracture or stress fracture of the patella or accessory ossiWcation centers of the patella [3]. Okuno et al. [4] also described traumatic separation of a type I bipartite patella and bone union was obtained in their conservatively treated cases. However, these cases may also represent a transverse fracture or transverse stress fracture of the distal part of the patella. Another concern is the existence of the developmental anomaly of ossiWcation type bipartite patella at the lower part of the patella. In our previous clinical studies of the bipartite or tripartite patella, the developmental anomaly of ossiWcation type bipartite patella did not exist at the lower part of the patella [5]. Ogden [6] also mentioned that a separate ossiWcation center at the inferior pole probably does not exist. Thus, the existence of the developmental anomaly of ossiWcation type bipartite patella at the lower part of the patella is questionable. Several diseases such as Sinding-Larsen–Johansson lesion, fragmentations of the distal part of the patella associated with spastic cerebral palsy and transverse fracture or stress fracture could be included when bipartite fragment was observed at the distal part of the patella [5]. However, Sinding-Larsen–Johansson lesion and fragmentations of the distal part of the patella associated with spastic cerebral palsy could be excluded in this case. Therefore, Wnally, transverse fracture or stress fracture of the distal part of the patella may be suspected.

The “Coiling-Up Procedure”: A Novel Technique for Extra-Articular Arthroscopy

The “coiling-up procedure” is a novel technique for extra-articular arthroscopy. A coil-shaped lifter is used to create the extra-articular working space, and a dry arthroscopy is performed. It can be combined with conventional intra-articular arthroscopy to enable direct vision from both inside and outside the joint. We have successfully used this technique to perform a vastus lateralis release in cases of painful bipartite patella. This is an innovative technique that offers the possibility of expanding the indications for extra-articular arthroscopy to other areas of the body. We describe in detail the technique for this new procedure in the knee.

An Usual Painful Bipartite Patella

Most bipartite patellae are asymptomatic and observed only as an incidental finding when the knee is radiographed for other reasons. Although bipartite patella is usually asymptomatic, it can become painful in subjects following overuse or injury. Most of the patients with painful bipartite patella respond relatively well to nonsurgical treatment. When the pain is persistent and resistant to those conservative treatments, a certain type of surgical procedures can be applied. In this report, we present a case of symptomatic bipartite patella in a patient with no underlying disease.

Symptomatic Bipartite Patella: Treatment Alternatives

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.

Excision of Painful Bipartite Patella: Good Long-term Outcome in Young Adults

Excision of the accessory bipartite fragment is widely used, but its long-term outcome is not known. We evaluated the outcome after surgical excision of a symptomatic accessory bipartite or multipartite patella fragment in young adult men performing their compulsory military service and determined the incidence of painful bipartite patellae in this group of skeletally mature adults. We followed 25 of 32 patients for a minimum of 10 years (mean, 15 years; range, 10-22 years). The incidence of painful, surgically treated bipartite patella was 9.2 per 100,000 recruits. Patients' median age at surgery was 20 years. There were 19 superolateral and six lateral bipartite fragments. Other radiographic findings were rare. At followup, the Kujala score mean was 95 points (range, 75-100 points), and osteoarthrotic changes (Kellgren-Lawrence Grade 1) were seen in two knees. No reoperations related to bipartite patella occurred during the followup. Symptomatic bipartite patella is rare and does not seem primarily associated with anatomic deviations, but when incapacitating pain persists despite nonoperative treatment, surgical excision seems to yield reasonable functional outcome and quick recovery with no apparent adverse sequelae. Our data suggest there is no reason to avoid this technically undemanding procedure for treating persistent symptoms of bipartite patella in young adults. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Bone union of painful bipartite patella after treatment with low-intensity pulsed ultrasound: Report of two cases

We report two cases of painful bipartite patella in which bone union was achieved after treatment with low-intensity pulsed ultrasound. Both patients were 13-year-old males. Each received ultrasound (SAFHS®, EXOGEN) for 20 min a day. The interval between the onset of pain and ultrasound treatment was between 2 and 4 months. The patellar pain disappeared within two months after treatment in both cases. Bone union was seen radiographically at 4 months. Low-intensity pulsed ultrasound is a non-invasive treatment that appeared to be helpful in the management of two patients with painful bipartite patella.

Histopathological abnormalities in painful bipartite patellae in adolescents

The purpose of this study was to clarify the etiology of painful bipartite patella in adolescents by histopathological examination of excised specimens. We performed excision of a fragment of painful bipartite or tripartite patella from six patients (six knees). The articular cartilage, interposed tissue, bone, and bone marrow of the excised specimens were histologically examined. The articular cartilage was intact in all but two patellae. The predominant composition of the interposed tissue was fibrous tissue in one patient; fibrous tissue and fibrocartilage in four patients; and fibrous tissue, fibrocartilage, and hyaline cartilage in one patient. In the interposed tissue, diffuse degenerative and necrotic fibrocartilage was observed in four patients and focal necrotic fibrocartilage was seen in two patients. In all patients, the central region of the interposed tissue almost completely lacked blood vessels. Other histological features of the interposed tissue included necrosis of the trabecular bone in three patients, irregularly shaped spicules of immature bone in three patients, and fragments of hyaline cartilage in two patients. In all patients the bone marrow adjacent to the interposed tissue showed numerous small blood vessels, and trabecular bone surfaces and the fibrocartilage surface adjacent to this bone marrow was scalloped and lined with numerous osteoclasts. The striking histopathological features of the interposed tissue were fibrous tissue and necrosis of the fibrocartilage. These abnormalities may ultimately lead to the failure of an accessory ossification center to unite with the main portion of the patella.

Arthroscopic Excision of a Painful Bipartite Patella Fragment

Abstract Bipartite patella, although usually asymptomatic, can become a source of persistent pain following injury. When nonoperative treatments such as physiotherapy and rest fail to produce any resolution in the symptoms, surgery is usually performed. This may include excision of the painful fragment, lateral retinacular release, or detachment of the vastus lateralis insertion, generally performed as open surgical procedures. In the case of vastus lateralis release, however, there has been recent report of statistically better results using an arthroscopic technique. Furthermore, open partial patellectomy has been criticized as being invasive and at times requiring long postoperative rehabilitation. We describe the case of a 26-year-old man who presented with a painful bipartite patella fragment that had not responded symptomatically to nonsurgical treatment. The painful fragment was removed arthroscopically as a day case under a general anesthetic. This was carried out through 3 portals and involved the use of a combination of probe, periosteal elevator, and arthroscopic shaver. Using this technique, we were able to minimize the surgical trauma associated with an open surgical procedure. The early result of this case encourages the use of an arthroscopic technique for partial patellectomy in the surgical treatment of a bipartite patella.

Vastus lateralis release for painful bipartite patella

Purpose: The purpose of this study was to evaluate the efficacy of vastus lateralis release for painful bipartite patella. We have also compared the results of open method versus arthroscopic method using a holmium:YAG laser system (OmniPulse Holmium Laser System; Trimedyne Inc, Irvine, CA). Type of Study: This study was a nonrandomized control and cross-over trial. Methods: Fifteen patients with 17 painful bipartite patella who underwent vastus lateralis release were included in this study. The average age of patients was 14.3 ± 2.2 years. In 7 knees of 6 patients, vastus lateralis release was performed through a skin incision over the bipartite fragment, and in 10 knees of 9 patients, we performed the procedure arthroscopically with the holmium:YAG laser. We assessed clinical and radiographic data of the patients chronologically in both groups. Results: In all patients, pain over the fragment disappeared within 4 weeks after the operation, and all returned to their previous sports activities at an average of 3.1 ± 0.9 months postoperatively. Clinical assessment was classified as excellent in 13 knees and good in 4 knees. Bone union at 6 months after the operation was complete in 11 knees (64.7%) and incomplete in 6 knees (35.3%), and none of the knees was graded as not healed. Bone union in patients with an age of 15 or younger was significantly better than that in patients over 15 years of age (P <.05). Release under arthroscopy showed statistically better results in duration of knee effusion (P <.05), return of circumference of thigh (P <.05), and return of muscle strength (P <.05). Conclusions: Because vastus lateralis release is less invasive surgery with good results, we conclude that this procedure can be a first choice of operative treatment for painful bipartite patella.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 4 (April), 2002: pp 404–411

Patellar tendonitis: clinical and literature review

Patellar tendonitis: clinical and literature review

Painful bipartite patella following injury

We report nine rare cases of painful bipartile patella following injury to the knee, in seven non-athletic adults. Patients suffered with persistent anterior knee pain and localized tenderness over the superolateral aspect of the patella for an average of 2 years following injury. The clinical, radiographic and arthroscopic findings are described. Excision of the accessory bipartite fragment resulted in satisfactory relief of pain and complete restoration of the knee function in all patients at a mean follow-up of 10 months (range 3–36 months). Although painful bipartite patella may be considered rare it should be recognized as a cause of post-traumatic anterior pain in the adult.