Bipartite patella
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View Liz Silverstone's current disclosures- Bipartite patellae
A bipartite patella (two-part patella) is a patella with an unfused accessory ossification centre, typically at the superolateral aspect.
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Epidemiology
The superolateral accessory ossification centre of the patella is usually present by 12 years of age and may persist into adult life. Bipartite patella occurs in approximately 2% of the population, and occurs bilaterally in about 43% of cases. It is 9 times more common in males than in females 1.
Clinical presentation
A bipartite patella is usually discovered incidentally in asymptomatic individuals. Only 2% of patients with bipartite patella experience symptoms. It may cause anterior knee pain, especially after trauma, sports injury, or overuse.
Classification
The Saupe classification describes the bipartite patella according to the location of the secondary ossification centre 2:
type I: inferior pole ~1%
type II: lateral margin ~20-25%
type III: superolateral portion ~75%
Radiographic features
Plain radiograph
A weight-bearing skyline view may demonstrate separation of the accessory fragment, which may indicate a symptomatic bipartite patella 3.
MRI
Bone marrow oedema adjacent to the accessory fragment may indicate a symptomatic bipartite patella 3.
Treatment and prognosis
In the majority of cases, symptomatic bipartite patella improves without surgery. Surgical excision of the small fragment is recommended if conservative management fails and has been reported to give good results 3.
Differential diagnosis
patellar fracture: the volume of the fractured components is equivalent to that of a normal patella
multipartite patella: the volume of the true patella plus that of the smaller ossification centres is greater than that expected of a normal patella
References
- 1. Jeremy Rich, Dorothy E. Dean, Robert H. Powers. Forensic Medicine of the Lower Extremity. (2005) ISBN: 9781588292698 - Google Books
- 2. Kajetanek C, Thaunat M, Guimaraes T, Carnesecchi O, Daggett M, Sonnery-Cottet B. Arthroscopic Treatment of Painful Sinding-Larsen-Johansson Syndrome in a Professional Handball Player. Orthopaedics & Traumatology: Surgery & Research. 2016;102(5):677-80. doi:10.1016/j.otsr.2016.05.011 - Pubmed
- 3. Atesok K, Doral M, Lowe J, Finsterbush A. Symptomatic Bipartite Patella: Treatment Alternatives. J Am Acad Orthop Surg. 2008;16(8):455-61. doi:10.5435/00124635-200808000-00004 - Pubmed
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- Bipartite patella - symptomatic
- Multipartite patella
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- Symptomatic bipartite patella type 1
- Bilateral bipartite patella
- Avulsion fractures of anterior and posterior cruciate ligaments
- Bipartite patella
- Bipartite patella
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- Bipartite patella - bilateral
- Tripartite patella
- Multipartite patella
- Bipartite patella - symptomatic
- Bipartite patella - type I
- Bipartite patella
- Patella fracture
- Bipartite patella
- Patellar fracture - non-displaced (MRI)
- Bipartite patella - type I
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