What is Bipartite Patella?
Bipartite Patella is normally a benign condition in which the patella is formed of two bones instead of one bone which is the norm for everyone.1 Patella or the kneecap is present in front of the knee. Bipartite Patella results from congenital fragmentation of the patella. When a child is born, then the child may have patella as two bones but as the child grows these two bones fuse together to form a single bone but in some cases this does not happen resulting in what we call as Bipartite Patella.
Bipartite Patella is not that common in the United States and occurs in about 3% of the population. As Bipartite Patella is asymptomatic and does not cause any symptoms hence this condition remains unobserved until a radiologic study is done of the area for some other reason and Bipartite Patella is identified. Only about a fraction of the people affected with Bipartite Patella experience pain. Bipartite Patella is believed to be present in children and young adults who are extremely active in sports. In some cases adults involved in heavy laborious work like heavy lifting, pushing and pulling can also have Bipartite Patella. This condition is seen mostly in boys than in girls.
What are the Causes of Bipartite Patella?
As stated, Bipartite Patella is more often than not asymptomatic and does not cause any symptoms and may remain unobserved for many years until it is found incidentally but there are certain factors that may trigger an inflammation and cause pain. These factors are:
- Direct trauma to the patella 2
- Falling awkwardly on the knee like during a long jump in track and field events
- Bipartite Patella can also be caused due to overuse and injury to the patella causing pain.
- Repetitive injuries during biking or climbing up a hill.
What are the Symptoms of Bipartite Patella?
Bipartite Patella is normally asymptomatic, although if Bipartite Patella gets irritated due to any reason some of which are mentioned above it may result in certain symptoms which are:
- Pain in the anterior part of the knee 3
- Inflammation of the knee
- Pain localized to the knee with no radiation of pain may be a symptoms of Bipartite Patella
- Presence of a bony bump on the region of the kneecap
- A sensation that the knee is unstable and is about to give way
- Pain with movement of the knee.
How is Bipartite Patella Diagnosed?
Bipartite Patella normally is diagnosed incidentally when radiological studies are done of the knee region for some other reason.4 Once Bipartite Patella is seen on x-rays, the physician may also order an MRI scan to better visualize the Bipartite Patella and may also order a bone scan for a confirmative diagnosis and whether there are any complications due to the Bipartite Patella.
What is the Treatment for Bipartite Patella?
Bipartite Patella does not require any treatment as it is an asymptomatic condition, although if there is a case of an irritated Bipartite Patella then pain that results from it can be controlled with NSAIDs like Tylenol or ibuprofen or other pain medications. Some of the treatment methods utilized for treatment of Bipartite Patella are:
Rest: Take plenty of rest if you are suffering from pain due to Bipartite Patella and not do any activities that may further irritate the Bipartite Patella and worsen the condition. Rest allows the pain to calm down. During the period of rest try and avoid activities like running, jumping, squatting, or climbing stairs. In cases where there is a separation of the synchondrosis which is the tissue that connects the two parts of the bones of the kneecap then physicians recommend complete rest for at least a period of six months or so for complete recovery. During the rest period activity modification is also recommended so as not to increase the severity of the condition.
Immobilization: Immobilization of the knee is also quite useful for treating pain symptoms caused by Bipartite Patella. It also provides stability to the knee and prevents any further injury to the knee. Immobilization can be done using knee braces as they also help with range of motion of the knee
Ultrasound: This is used by physical therapist along with interferential current for pain relief and decreasing swelling.
Physical Therapy for Bipartite Patella: This is perhaps the most vital aspect in treatment of Bipartite Patella. This is started once the pain and swelling has calmed down and the patient is able to move the affected leg somewhat. Physical therapy is started with gentle stretching exercises. Once the patient is able to do these exercises without any discomfort then strengthening exercises are started as it is important to strengthen the surrounding muscles like the thigh, buttocks, and calf.
Surgery for Bipartite Patella: This is reserved as a last resort and the most preferred surgery for correcting Bipartite Patella is excision procedure of the accessory fragment. Other procedures that can be done are lateral retinacular release and ORIF.
What is the Recovery Period of Bipartite Patella?
Once Bipartite Patella is removed with surgical excision procedure then the patient will get immediate relief from the symptoms. If an open excision is done which is by far the most preferred surgery to treat Bipartite Patella then recovery may take at least 4-6 months before the patient can get back to normal activities of daily living after correcting the Bipartite Patella. If conservative approaches are good enough for treatment then the patient can completely recover in two to three months from a Bipartite Patella.