Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusion
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.
Level of evidence
V.
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References
Adachi N, Ochi M, Yamaguchi H, Uchio Y, Kuriwaka M (2002) Vastus lateralis release for painful bipartite patella. Arthroscopy 18:404–411
Blumensaat C (1932) Patella partita-Traumatische Spaltpatella-Patellarfraktur. Arch Orthop Chir 32:263–282
Bourne MH, Bianco AJ (1990) Bipartite patella in the adolescent: results of surgical excision. J Pediatr Orthop 10:69–73
Canizares GH, Selesnick FH (2003) Bipartite patella fracture. Arthroscopy 19:215–217
Carney J, Thompson D, O’Daniel J, Cassidy J (2010) Arthroscopic excision of a painful bipartite patella fragment. Am J Orthop 39:40–43
Carter SR (1989) Traumatic separation of a bipartite patella. Injury 20:244
Collings CL (1994) Scintigraphic findings on examination of the multipartite patella. Clin Nucl Med 19:865–866
Enomoto H, Nagosi N, Okada E, Ota N, Iwabu S, Kamiishi S (2006) Hemilaterally symptomatic bipartite patella associated with bone erosions arising from a gouty tophus: a case report. Knee 13:474–477
Felli L, Fiore M, Biglieni L (2011) Arthroscopic treatment of symptomatic bipartite patella. Knee Surg Sports Traumatol Arthrosc 19:398–399
George R (1935) Bilateral bipartite patellae. Br J Surg 22:555–560
Gorva AD, Siddique I, Mohan R (2006) An unusual case of bipartite patella fracture with quadriceps rupture. Eur J Trauma 4:411–413
Green WT (1975) Painful bipartite patellae. Clin Orthop Relat Res 110:197–200
Halpern AA, Hewitt O (1978) Painful medial bipartite patellae. A case report. Clin Orthop Relat Res 134:180–181
Iossifidis A, Brueton RN (1995) Painful bipartite patella following injury. Injury 26:175–176
Iossifidis A, Brueton RN, Nunan TO (1995) Bone-scintigraphy in painful bipartite patella. Eur J Nucl Med 22:1212–1213
Ireland ML, Chang JL (1995) Acute fracture bipartite patella: case report and literature review. Med Sci Sports Exerc 27:299–302
Ishikawa H, Sakurai A, Hirata S, Ohno O, Kita K, Sato T, Kashiwagi D (1994) Painful bipartite patella in young athletes. Clin Orthop Relat Res 305:223–228
Kavanagh EC, Zoga A, Omar I, Ford S, Schweitzer M, Eustace S (2007) MRI findings in bipartite patellae. Skelet Radiol 36:209–214
Kobayashi K, Deie M, Okuhara A, Adachi N, Yasumoto M, Ochi M (2005) Tophaceous gout in the bipartite patella with intra-osseous and intra-articular lesions: a case report. J Orthop Surg (Hong Kong) 13:199–202
Mori Y, Okumo H, Iketani H, Kuroki Y (1995) Efficacy of lateral retinacular release for painful bipartite patella. Am J Sports Med 23:13–18
O’Brien J, Murphy C, Halpenny D, McNeill G, Torreggiani WC (2011) Magnetic resonance imaging features of asymptomatic bipartite patella. Eur J Radiol 78:425–429
Ogata K (1994) Painful bipartite patella. A new approach to operative treatment. J Bone Joint Surg Am 76:573–578
Ogden JA, McCarthy SM, Jokl P (1982) The painful bipartite patella. J Pediatr Orthop 2:263–269
Ogden JA (1984) Radiology of postnatal skeletal development. X. Patella and tibial tuberosity. Skelet Radiol 11:246–257
Oohashi Y, Noriki S, Koshino T, Fukuda M (2006) Histopathological abnormalities in painful bipartite patellae in adolescents. Knee 13:189–193
Oohashi Y, Koshino T (2007) Bone scintigraphy in patients with bipartite patella. Knee Surg Traumatol Arthrosc 15:1395–1399
Oohashi Y, Koshino T, Oohashi Y (2010) Clinical features and classification of bipartite or tripartite patella. Knee Surg Traumatol Arthrosc 18:1465–1469
Oohashi Y, Koshino T, Oohashi Y (2010) Natural history of the supero-lateral bipartite fragment of the patella in children. J Orthop 7(4):e5
Paas HR (1931) Zur Frage der Patella partita und ihrer Entstehung unter besonderer Berücksichtigung der Schrägteilung. Dtsch Z Chir 230:261–277
Puddu G, Mariani PP, Alzani R (1978) Detachment of the accessory fragment in “patella partita”. Ital J Orthop Traumatol 4:197–203
Reber P, Crevoisier X, Noesberger B (1996) Unusual localisation of tophaceous gout. A report of four cases and review of the literature. Arch Orthop Trauma Surg 115:297–299
Rosenthal RK, Levine DB (1977) Fragmentation of the distal pole of the patella in spastic cerebral palsy. J Bone Joint Surg Am 59:934–939
Saupe E (1921) Beitrag zur Patella bipartita. Fortschr Röntgenstr 28:37–41
Siemens W (1931) Patella partita. Dtsch Z Chir 233:727–755
Sinding-Larsen MF (1921) A hitherto unknown affection of the patella in children. Acta Radiol 1:171–173
Tashiro S, Sugita T, Nakamura S, Kurata Y (2002) Gout tophus in the bipartite patella. Orthopedics 25:1295–1296
Thomas AL, Wilson RH, Thompson TL (2007) Quadriceps avulsion through a bipartite patella. Orthopedics 30:491–492
Tonotsuka H, Yamamoto Y (2008) Separation of a bipartite patella combined with quadriceps tendon rupture: a case report. Knee 15:64–67
Weaver JK (1977) Bipartite patellae as a cause of disability in the athlete. Am J Sports Med 5:137–143
Weckström M, Parviainen M, Pihlajamäki HK (2008) Excision of painful bipartite patella. Good long-term outcome in young adults. Clin Orthop Relat Res 466:2848–2855
Woods GW, O’Connor DP, Elkousy HA (2007) Quadriceps tendon rupture through a superolateral bipartite patella. J Knee Surg 20:293–295
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Oohashi, Y. Developmental anomaly of ossification type patella partita. Knee Surg Sports Traumatol Arthrosc 23, 1071–1076 (2015). https://doi.org/10.1007/s00167-014-2887-7
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DOI: https://doi.org/10.1007/s00167-014-2887-7