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Patellar Contusion

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Common Pediatric Knee Injuries

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Abstract

Patellar contusions are very common among the pediatric population. Contusions are most frequently caused by direct blunt-force trauma during casual play or organized sports. Patellar contusion is usually radiographically occult. The hyperemia and increased edema in the subchondral bone can be visualized on T2-weighted magnetic resonance imaging. Although complications can arise, patella contusions are typically self-limiting and resolve with appropriate conservative care. Patient education, activity modification, and pain management are cornerstones of treatment. The overwhelming majority of patients will return to play at their previous level once recovered from a patella contusion. Patellar contusion is occasionally complicated by prepatellar bursitis or patella fracture. Patellar subluxation also produces a characteristic pattern of patellar marrow edema, which usually distinguishes it from patella contusion, especially with supporting history and exam findings. Due to delayed or abnormal fusion of the secondary ossification centers, a bipartite or tripartite patella may be seen in the pediatric population. Although this abnormality is typically asymptomatic, a bipartite patella can become painful with overuse or after direct trauma. Care should also be taken in the clinical setting to distinguish a bipartite patella from an acute fracture.

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References

  1. Gettys F, Morgan R, Fleischli J. Superior pole sleeve fracture of the Patella: a case report and review of the literature. Am J Sports Med. 2010;38(11):2331–6.

    Article  PubMed  Google Scholar 

  2. Schmal H, Strohm P, Niemeyer P, Reising K, Kuminack K, Sudkam N. Fractures of the patella in children and adolescents. Acta Orthop Belg. 2010;76(5):644–50.

    PubMed  Google Scholar 

  3. Mandalia V, Fogg A, Chari R, Murray J, Beale A, Henson J. Bone bruising of the knee. Clin Radiol. 2005;60(6):627–36.

    Article  CAS  PubMed  Google Scholar 

  4. Rangger C, Kathrein A, Freund M, Klestil T, Kreczy A. Bone bruise of the knee: histology and cryosections in 5 cases. Acta Orthop Scand. 1998;69(3):291–4.

    Article  CAS  PubMed  Google Scholar 

  5. Wilson A, Murphy W, Hardy D, Totty W. Transient osteoporosis: transient bone marrow edema? Radiology. 1988;167(3):663–7.

    Article  Google Scholar 

  6. Sanders T, Medynski M, Feller J, Lawhorn K. Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. Radiographics. 2000;20(Special Issue):S135–51.

    Article  PubMed  Google Scholar 

  7. Zaidi A, Babyn P, Astori I, White L, Doria A, Cole W. MRI of traumatic patellar dislocation in children. Pediatr Radiol. 2006;36(11):1163–70.

    Article  PubMed  Google Scholar 

  8. Gomez J, Molina D, Rettig S, Kan J. Bone bruises in children and adolescents not associated with ligament ruptures. Orthop J Sports Med. 2018;6(7).

    Google Scholar 

  9. Gaheer R, Kapoor S, Rysavy M. Contemporary management of symptomatic bipartite patella. Orthopedics. 2009;32(11):843–9.

    Article  Google Scholar 

  10. Canizares G, Selesnick F. Bipartite patella fracture. Arthroscopy. 2003;19(2):215–7.

    Article  PubMed  Google Scholar 

  11. Carter S. Traumatic Separation of a bipartite Patella. Injury. 1989;20(4):244.

    Article  CAS  PubMed  Google Scholar 

  12. Thomas A, Wilson R, Thompson T. Quadriceps avulsion through a bipartite patella. Orthopedics. 2007;30(6):491–2.

    Article  PubMed  Google Scholar 

  13. Kavanagh E, Zoga A, Omar I, Ford S, Schweitzer M, Eustace S. MRI findings in bipartite patella. Skelet Radiol. 2007;36(3):209–14.

    Article  Google Scholar 

  14. Saupe H. Primäre Krochenmark serelung der kniescheibe. Deustsche Z Chir. 1943;258:386–92.

    Article  Google Scholar 

  15. Weaver J. Bipartite patella as a cause of disability in the athlete. Am J Sports Med. 1977;5(4):137–43.

    Article  CAS  PubMed  Google Scholar 

  16. Halpem A, Hewitt O. Painful medial bipartite patella: A case report. Clin Orthop Relat Res. 1978;(134):180–1.

    Google Scholar 

  17. Iossifidis A, Brueton R. Painful bipartite patella following injury. Injury. 1995;26(3):175–6.

    Article  CAS  PubMed  Google Scholar 

  18. Okuno H, Sugita T, Kawamata T, Ohnuma M, Yamad N, Yoshizumi Y. Traumatic separation of a type 1 bipartite patella: a report of four knees. Clin Orthop Relat Res. 2004;420:257–60.

    Article  Google Scholar 

  19. Echeverria T, Bersani F. Acute fracture simulating a symptomatic bipartite patella. Am J Sports Med. 1980;8(1):48–50.

    Article  CAS  PubMed  Google Scholar 

  20. Ma J, Shi F, Huang C, Gu S. Forensic identification of bipartite patella misdiagnosed as patella fracture. J Forensic Sci. 2017;62(4):1089–91.

    Article  PubMed  Google Scholar 

  21. O’Brien J, Murphy C, Halpenny C, McNeill G. WC. T. Magnetic resonance imaging features of asymptomatic bipartite patella. Eur J Radiol. 2011;78(3):425–9.

    Article  PubMed  Google Scholar 

  22. McMahon S, LeRoux J, Smith T, Hing C. The management of the painful bipartite patella: a systematic review. Knee Surg Sports Traumatol Arhtrosc. 2015;24(9):2798–805.

    Article  Google Scholar 

  23. Collings C. Scintigraphic findings on examination of the multipartite patella. Clin Nucl Med. 1994;19(10):865–6.

    Article  CAS  PubMed  Google Scholar 

  24. Gage B, McIlvain N, Collins C, Fields S, Comstock R. Epidemiology of 6.6 million knee injuries presenting to United States emergency departments from 1999t Through 2008. Acad Emerg Med. 2012;19(4):1553–2712.

    Article  Google Scholar 

  25. Moustaki M, Pitsos N, Dalamaga M, Dessypris N, Petridou E. Home and leisure activities and childhood knee injuries. Injury. 2005;36(5):644–50.

    Article  CAS  PubMed  Google Scholar 

  26. Majewski M, Susanne H, Klaus S. Epidemiology of athletic knee injuries: a 10-year study. Knee. 2006;13(3):184–8.

    Article  CAS  PubMed  Google Scholar 

  27. Simon T, Bublitz CHS. Emergency department visits among pediatric patients for sports-related injury: basic epidemiology and impact of race/ethnicity and insurance status. Pediatr Emerg Care. 2006;22(5):309–15.

    Article  PubMed  Google Scholar 

  28. Louw Q, Manilall J, Grimmer K. Epidemiology of knee injuries among adolescents: a systematic review. Br J Sports Med. 2008;42(1):2–10.

    Article  CAS  PubMed  Google Scholar 

  29. Weber J, Jackson R, Peacock W, Swor R, Carley R, Larkin G. Clinical decision rules discriminate between fractures and nonfractures in acute isolated knee trauma. Ann Emerg Med. 1995;26(4):429–33.

    Article  CAS  PubMed  Google Scholar 

  30. Stiell I, Greenburg G, Wells G, McKnight R, Cwinn A, Cacciotti T, et al. Derivation of a decision rule for the use of radiography in acute knee injures. Ann Emerg Med. 1995;26(4):405–13.

    Article  CAS  PubMed  Google Scholar 

  31. Seaberg D, Jackson R. Clinical decision rule for knee radiographs. Am J Emerg Med. 1994;12(5):541–3.

    Article  CAS  PubMed  Google Scholar 

  32. Tandeter H, Shvartzman P. Acute knee injuries: use of decision rules for selective radiograph ordering. Am Fam Physician. 1999;60(9):2599–608.

    CAS  PubMed  Google Scholar 

  33. Bachmann LM, Haberzeth S, Steurer J, ter Riet G. The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review. Ann Intern Med. 2004;140(2):121–4.

    Article  PubMed  Google Scholar 

  34. Cheung T, Tank Y, Breederveld R, Tuinebreijer W, de Lange-de Klerk E, Derksen R. Diagnostic accuracy and reproducibility of the Ottawa knee rule vs the Pittsburgh decision rule. Am J Emerg Med 2013; 31(4): p. 641–645.

    Article  PubMed  Google Scholar 

  35. Konan S, Zang T, Tamimi N, Haddad F. Can the Ottawa and Pittsburgh rules reduce requests for radiography in patients referred to acute knee clinics? Ann R Coll Surg Engl. 2013;95(3):188–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Vijayasankar D, Boyle AA, Atkinson P. Can the Ottawa knee rule be applied to children? A systematic review and meta-analysis of observational studies. Emerg Med J. 2009;26(4):250–3.

    Article  CAS  PubMed  Google Scholar 

  37. Chatra P. Bursae around the knee joints. Indian J Radiol Imaging. 2012;22:27–30.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Samin M, Smitaman E, Lawrence D, Moukaddam H. MRI of anterior knee pain. Skeltal Radiol. 2014;43:875–93.

    Article  Google Scholar 

  39. Khodaee M. Common superficial bursitis. Am Fam Physician. 2017;95(4):224–31.

    PubMed  Google Scholar 

  40. Sebastian F, Baumbach S, Lobo C, Badyine I, Mutschler W, Kanz K. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Arch Orthop Trauma Surg. 2014;134(3):359–70.

    Article  Google Scholar 

  41. McAfee J, Smith D. Olecranon and prepatellar bursitis. Diagnosis and treatment. West J Med. 1988;149(5):607–10.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. Palumbo P. Dynamic patellar brace: a new orthosis in the management of patellofemoral disorders. Am J Sports Med. 1981;9(1):45–9.

    Article  PubMed  Google Scholar 

  43. Stocker R, van Laer L. Injury of a bipartite patella in a young upcoming sportsman. Arch Orthop Trauma Surg. 2011;131(1):75–8.

    Article  PubMed  Google Scholar 

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Disclosure

The opinions expressed herein are those of the authors, and do not represent official policy of the US Air Force or the Department of Defense.

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Authors and Affiliations

  1. University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Clinton J. Ulmer

  2. Sports Medicine Clinic, Fort Belvoir Community Hospital, Ft. Belvoir, VA, USA

    Nathaniel S. Nye

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  1. Clinton J. Ulmer
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  2. Nathaniel S. Nye
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Correspondence to Nathaniel S. Nye .

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Editors and Affiliations

  1. Children’s National Hospital, Washington, DC, USA

    Nailah Coleman

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Ulmer, C.J., Nye, N.S. (2021). Patellar Contusion. In: Coleman, N. (eds) Common Pediatric Knee Injuries. Springer, Cham. https://doi.org/10.1007/978-3-030-55870-3_7

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  • DOI: https://doi.org/10.1007/978-3-030-55870-3_7

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-55870-3

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