Advertisement

Clinical Orthopaedics and Related Research

, Volume 466, Issue 11, pp 2848–2855 | Cite as

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

  • Maria WeckströmEmail author
  • Mickael Parviainen
  • Harri K. Pihlajamäki
Original Article

Abstract

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 of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Keywords

Military Service Osteochondritis Dissecans Sulcus Angle Kujala Score Bipartite Patella 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Olli Kiviluoto, Pekka Jokio, Tuomo Visuri, Kalevi Hietaniemi, Veli-Matti Nurmi, and Kai Turula, orthopaedic surgeons from the Central Military Hospital, Finland, for their contributions in the operations reported in this study.

References

  1. 1.
    Adachi N, Ochi M, Yamaguchi H, Uchio Y, Kuriwaka M. Vastus lateralis release for painful bipartite patella. Arthroscopy. 2002;18:404–411.PubMedGoogle Scholar
  2. 2.
    Adams JD, Leonard RD. A developmental anomaly of the patella frequently diagnosed as fracture. Surg Gynecol Obstet. 1925;41:601–604.Google Scholar
  3. 3.
    Azarbod P, Agar G, Patel V. Arthroscopic excision of a painful bipartite patella fragment. Arthroscopy. 2005;21:1006.PubMedGoogle Scholar
  4. 4.
    Blankstein A, Cohen I, Salai M, Diamant L, Chechick A, Ganel A. Ultrasonography: an imaging modality enabling the diagnosis of bipartite patella. Knee Surg Sports Traumatol Arthrosc. 2001;9:221–224.PubMedGoogle Scholar
  5. 5.
    Bourne MH, Bianco AJ Jr. Bipartite patella in the adolescent: results of surgical excision. J Pediatr Orthop. 1990;10:69–73.PubMedGoogle Scholar
  6. 6.
    Canizares GH, Selesnick FH. Bipartite patella fracture. Arthroscopy. 2003;19:215–217.PubMedGoogle Scholar
  7. 7.
    Devas MB. Stress fractures of the patella. J Bone Joint Surg Br. 1960;42:71–74.PubMedGoogle Scholar
  8. 8.
    George R. Bilateral bipartite patellae. Br J Surg. 1935;22:550–560.CrossRefGoogle Scholar
  9. 9.
    Green WT Jr. Painful bipartite patellae: a report of three cases. Clin Orthop Relat Res. 1975;110:197–200.PubMedCrossRefGoogle Scholar
  10. 10.
    Gruber W. In Bildungsanomalie mit Bildungshemmung begründete Bipartition beider Patellae eines jungen Subjectes. Virchows Arch. 1883;94:358–361.CrossRefGoogle Scholar
  11. 11.
    Halpern AA, Hewitt O. Painful medial bipartite patellae: a case report. Clin Orthop Relat Res. 1978;134:180–181.PubMedGoogle Scholar
  12. 12.
    Insall J, Salvati E. Patella position in the normal knee joint. Radiology. 1971;101:101–104.PubMedGoogle Scholar
  13. 13.
    Iossifidis A, Brueton RN. Painful bipartite patella following injury. Injury. 1995;26:175–176.PubMedCrossRefGoogle Scholar
  14. 14.
    Ishikawa H, Sakurai A, Hirata S, Ohno O, Kita K, Sato T, Kashiwagi D. Painful bipartite patella in young athletes: the diagnostic value of skyline views taken in squatting position and the results of surgical excision. Clin Orthop Relat Res. 1994;305:223–228.PubMedCrossRefGoogle Scholar
  15. 15.
    Kavanagh EC, Zoga A, Omar I, Ford S, Schweitzer M, Eustace S. MRI findings in bipartite patella. Skeletal Radiol. 2007;36:209–214.PubMedCrossRefGoogle Scholar
  16. 16.
    Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494–502.PubMedCrossRefGoogle Scholar
  17. 17.
    Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O. Scoring of patellofemoral disorders. Arthroscopy. 1993;9:159–163.PubMedCrossRefGoogle Scholar
  18. 18.
    Laurin CA, Lévesque HP, Dussault R, Labelle H, Peides JP. The abnormal lateral patellofemoral angle: a diagnostic roentgenographic sign of recurrent patellar subluxation. J Bone Joint Surg Am. 1978;60:55–60.PubMedGoogle Scholar
  19. 19.
    Llewellyn-Jones D, Abraham SF. Quetelet index in diagnosis of anorexia nervosa. Br Med J (Clin Res Ed). 1984;288:1800.CrossRefGoogle Scholar
  20. 20.
    Merchant AC, Mercer RL, Jacobsen RH, Cool CR. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am. 1974;56:1391–1396.PubMedGoogle Scholar
  21. 21.
    Mori Y, Okumo H, Iketani H, Kuroki Y. Efficacy of lateral retinacular release for painful bipartite patella. Am J Sports Med. 1995;23:13–18.PubMedCrossRefGoogle Scholar
  22. 22.
    Ogata K. Painful bipartite patella: a new approach to operative treatment. J Bone Joint Surg Am. 1994;76:573–578.PubMedGoogle Scholar
  23. 23.
    Ogden JA, McCarthy SM, Jokl P. The painful bipartite patella. J Pediatr Orthop. 1982;2:263–269.PubMedGoogle Scholar
  24. 24.
    Oohashi Y, Noriki S, Koshino T, Fukuda M. Histopathological abnormalities in painful bipartite patellae in adolescents. Knee. 2006;13:189–193.PubMedCrossRefGoogle Scholar
  25. 25.
    Saupe E. Beitrag zur Patella bipartita. Fortschr Röntgenstr. 1921;28:37–41.Google Scholar
  26. 26.
    Smillie IS. Injuries of extensor apparatus. In: Injuries of the Knee Joint. 3rd Ed. Baltimore, MD: Williams & Wilkins; 1962:272–277.Google Scholar
  27. 27.
    Tietjens BR, Aitken GK, Walsh SJ. Symptomatic bipartite patella. J Bone Joint Surg Br. 1992;74(suppl III):267.Google Scholar
  28. 28.
    Todd TW, McCally WC. Defects of the patellar border. Ann Surg. 1921;74:775–782.PubMedCrossRefGoogle Scholar
  29. 29.
    van Holsbeeck M, Vandamme B, Marchal G, Martens M, Victor J, Baert AL. Dorsal defect of the patella: concepts of its origin and relationship with bipartite and multipartite patella. Skeletal Radiol. 1987;16:304–311.PubMedCrossRefGoogle Scholar
  30. 30.
    Weaver JK. Bipartite patella as a cause of disability in the athlete. Am J Sports Med. 1977;5:137–143.PubMedCrossRefGoogle Scholar
  31. 31.
    Weckström M, Parviainen M, Kiuru MJ, Mattila VM, Pihlajamäki HK. Comparison of bioabsorbable pins and nails in the fixation of adult osteochondritis dissecans fragments of the knee: an outcome of 30 knees. Am J Sports Med. 2007;35:1467–1476.PubMedCrossRefGoogle Scholar
  32. 32.
    World Health Organization. Physical status: the use and interpretation of anthropometry. Report of a WHO expert committee. WHO Technical Report Series 854. 1995;420:433–452.Google Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Maria Weckström
    • 1
    • 2
    Email author
  • Mickael Parviainen
    • 2
  • Harri K. Pihlajamäki
    • 2
    • 3
  1. 1.Centre for Military Medicine, Research DepartmentLahtiFinland
  2. 2.Department of Orthopaedic SurgeryCentral Military HospitalHelsinkiFinland
  3. 3.Centre for Military Medicine, Research DepartmentHelsinkiFinland

Personalised recommendations