Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 9, pp 2798–2805 | Cite as

The management of the painful bipartite patella: a systematic review

  • Samuel E. McMahonEmail author
  • Johannes A. LeRoux
  • Toby O. Smith
  • Caroline B. Hing



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.

Level of evidence



Patella Bipartite Multipartite 


Conflict of interest



  1. 1.
    Adachi N, Ochi M, Yamaguchi H, Uchio Y, Kuriwaka M (2002) Vastus lateralis release for painful bipartite patella. Arthroscopy 18(4):404–441CrossRefPubMedGoogle Scholar
  2. 2.
    Azarbod P, Agar G, Patel V (2005) Arthroscopic excision of a painful bipartite patella fragment. Arthroscopy 21(8):1006CrossRefPubMedGoogle Scholar
  3. 3.
    Bourne MH, Bianco AJ (1990) Bipartite patella in the adolescent: results of surgical excision. J Pediatr Orthop 10:69–73CrossRefPubMedGoogle Scholar
  4. 4.
    Canizares GH, Selesnick FH (2003) Bipartite patella fracture. Arthroscopy 19(2):215–217CrossRefPubMedGoogle Scholar
  5. 5.
    Carney J, Thompson D, O’Daniel J, Cassidy J (2010) Arthroscopic excision of a painful bipartite patella fragment. Am J Orthop 39(1):40–43PubMedGoogle Scholar
  6. 6.
    Echeverria TS, Bersani FA (1980) Acute fracture simulating a symptomatic bipartite patella. Am J Sports Med 8(1):48–50CrossRefPubMedGoogle Scholar
  7. 7.
    Felli L, Fiore M, Biglieni L (2011) Arthroscopic treatment of symptomatic bipartite patella. Knee Surg Sports Traumatol Arthrosc 19(3):398–399CrossRefPubMedGoogle Scholar
  8. 8.
    Halpern AA, Hewitt O (1978) Painful medial bipartite patella. Clin Orthop Relat Res 134:180–181PubMedGoogle Scholar
  9. 9.
    Iossifidis A, Brueton RN (1995) Painful bipartite patella following injury. Injury 26:175–176CrossRefPubMedGoogle Scholar
  10. 10.
    Ireland ML, Chang JL (1995) Acute fracture bipartite patella: case report and literature review. Med Sci Sports Exerc 27(3):299–302CrossRefPubMedGoogle Scholar
  11. 11.
    Ishikawa H, Sakurai A, Hirata S, Ohno O, Kita K, Sato T, Kashiwagi D (1994) Painful bipartite patella in young athletes. The diagnostic value of skyline views in squatting position and surgical excision. Clin Orthop Relat Res 305:223–228CrossRefPubMedGoogle Scholar
  12. 12.
    Kumahashi N, Uchio Y, Iwasa J, Kawasaki K, Adachi N, Ochi M (2007) Bone union of painful bipartite patella after treatment with low-intensity pulsed ultrasound: report of two cases. Knee 15:50–53CrossRefPubMedGoogle Scholar
  13. 13.
    Marya KM, Yadav V, Devagan A, Kundu ZS (2003) Painful bilateral bipartite patellae—case report. Indian J Med Sci 57:66PubMedGoogle Scholar
  14. 14.
    Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Mori Y, Okumo H, Iketani H, Kuroki Y (1995) Efficacy of lateral retinacular release for painful bipartite patella. Am J Sports Med 23(1):13–18CrossRefPubMedGoogle Scholar
  16. 16.
    O’Brien J, Murphy C, Halpenny G, McNeill G, Torreggiani WC (2011) Magnetic resonance imaging features of asymptomatic bipartite patella. Eur J Radiol 78:425–429CrossRefPubMedGoogle Scholar
  17. 17.
    Ogata K (1994) Painful bipartite patella. A new approach to operative treatment. Bone Joint Surg Am 76(4):573–578Google Scholar
  18. 18.
    Ogden JA (1984) Radiology of postnatal skeletal development. X. Patella and tibial tuberosity. Skelet Radiol 11(4):246–257CrossRefGoogle Scholar
  19. 19.
    Okuno H, Sugita T, Kawamata T, Ohnuma M, Yamada N, Yoshizumi Y (2004) Traumatic separation of a type I bipartite patella: a report of four knees. Clin Orthop 420:257–260CrossRefPubMedGoogle Scholar
  20. 20.
    Oohashi Y, Koshino T, Oohashi Y (2010) Clinical features and classification of bipartite or tripartite patella. Knee Surg Sports Traumatol Arthrosc 18:1465–1469CrossRefPubMedGoogle Scholar
  21. 21.
    Peek AC, Barry M (2012) Patella fracture in a boy with bilateral inferior pole bipartite patellae. Knee 19(5):716–718CrossRefPubMedGoogle Scholar
  22. 22.
    Prakash S, Chopra SRK, Jit I (1979) Ossification of the human patella. J Anat Soc India 28:78–83Google Scholar
  23. 23.
    Saupe E (1921) Beitrag zur patella bipartita. Fortschr Rontgenstr 28:37–41Google Scholar
  24. 24.
    Stocker RL, van Laer L (2011) Injury of a bipartite patella in a young upcoming sportsman. Arch Orthop Trauma Surg 131:75–78CrossRefPubMedGoogle Scholar
  25. 25.
    Tauber M, Matis N, Resch H (2007) Traumatic separation of an uncommon bipartite patella type: a case report. Knee Surg Sports Traumatol Arthrosc 15(1):83–88CrossRefPubMedGoogle Scholar
  26. 26.
    Weaver JK (1977) Bipartite patellae as a cause of disability in the athlete. Am J Sports Med 5:137–143CrossRefPubMedGoogle Scholar
  27. 27.
    Weckström M, Parviainen M, Pihlajamäki HK (2008) Excision of painful bipartite patella: good long-term outcome in young adults. Clin Orthop Relat Res 466(11):2848–2855CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Werner S, Durkan M, Jones J, Quilici S, Crawford D (2013) Symptomatic bipartite patella: three subtypes, three representative cases. J Knee Surg 26(Suppl. 1):72–76Google Scholar
  29. 29.
    Wong CK (2009) Bipartite patella in a young athlete. J Orthop Sports Phys Ther 39(7):560CrossRefPubMedGoogle Scholar
  30. 30.
    Yoo JH, Kim EH, Ryu HW (2008) Arthroscopic removal of separated bipartite patella causing snapping knee syndrome. Orthopaedics 31(7):717Google Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Samuel E. McMahon
    • 1
    Email author
  • Johannes A. LeRoux
    • 2
  • Toby O. Smith
    • 3
  • Caroline B. Hing
    • 4
  1. 1.Department of Trauma and OrthopaedicsRoyal Victoria HospitalBelfastUK
  2. 2.Department of Trauma and OrthopaedicsTygerberg HospitalCape TownSouth Africa
  3. 3.Faculty of Medicine and Health SciencesUniversity of East AngliaNorwichUK
  4. 4.Department of Trauma and OrthopaedicsSt George’s University LondonLondonUK

Personalised recommendations