Bipartite Patella : Symptoms, Diagnosis, and Treatment Options

Bipartite patella is a rare congenital condition that can become painful following direct trauma or an overuse injury. At times, despite various treatments, individuals may experience significant pain and might even require surgery.

This article delves into the intricacies of the bipartite patella, enhancing your understanding of its development, diagnosis, and management techniques.

Our patella, or kneecap, is a triangular-shaped bone located at the front of the knee. Approximately one to two percent of the population possess a bipartite patella, indicating their kneecap is comprised of two bones instead of the usual one.⁽¹⁾ A bipartite patella can manifest in either one or both knees.

Often, bipartite patella develops when a section of the patella does not fully heal along its bony edges. Despite its rarity, bipartite patella is generally asymptomatic. For most of those affected, the condition remains symptom-free. It’s typically discovered on an x-ray when an individual exhibits symptoms more commonly linked to another underlying condition.

Some individuals with a bipartite patella may experience localized pain over the superolateral patella or discomfort during activities like skiing and deep squats. While it often becomes apparent post-injury, this isn’t a consistent observation across all cases. Let’s further explore the development of the bipartite patella.

Bipartite patella is quite a rare phenomenon and only about 0.2% to 6% of incidence are reported. This condition occurs more often in males and is bilateral in 50% of cases.^{(2, 3)} Less than 2% of this affected population become symptomatic and require strict medical intervention.^{(4, 5)}

When we are born, our kneecap or patella is mostly made of cartilage and blood vessels. However, as we grow, the cartilage expands, and by the time someone is at 3 years to 5 years old, the cartilage begins to turn into bone. This process continues until they reach 10 years of their life. At this point, only a single kneecap or patella is formed.

However, because of some unknown cause, sometimes the bones do not fuse completely and thus create a bipartite patella. This extra bone is mostly near the lower bottom edge or the upper outer edge of the knee.

Most people having bipartite patella are never diagnosed, probably because it does not cause any symptoms in them. However, the condition will show up if you have an MRI scan or X-ray done in that specific area for any other unrelated condition.

But if we talk about the real diagnosis of a bipartite patella, then the best way to determine if the condition is symptomatic or not is through a physical examination. MRI scan could be used to determine if the bipartite patella is healed or not, or if there is any increased signal of the condition, which would indicate swelling at the fibrous healing zone of the bipartite patella or patella’s main area may indicate that there is an increasing risk that the condition is symptomatic. Other causes of the pain must also be investigated while diagnosing a bipartite patella.

Typically, a Bipartite patella doesn’t necessitate treatment unless it’s causing discomfort or pain. However, the treatment approach varies based on its presentation. Often, recommendations include physical therapy and activity modifications. Your doctor may advise resting the knee, applying ice to the patella, wearing a knee brace, taking nonsteroidal anti-inflammatory drugs, and undergoing physical therapy. Additionally, it’s wise to steer clear of activities that could exacerbate the condition, such as deep squats and lunges.

For patients who don’t respond to these treatments or experience severe knee pain associated with a bipartite patella, an injection into the fibrous union between the normal patella and the bipartite fragment might be effective.

However, if there is no improvement even after six months of trying all the above, you might require surgery. Let us walk through the information related to the surgical treatment of a bipartite patella.

There are several surgical options available for treating a bipartite patella. However, the most effective one is an arthroscopic excision of the bipartite patella. Usually, this procedure requires just three to four small incisions around the affected knee to take off the problematic portion of the patella, shell it out arthroscopically with a bur, and try saving the normal structure of the ligament on the lateral aspect of the patellofemoral joint.

Some other surgical treatments for bipartite patella could include the following.

• The surgery might include removing the smaller of the two bones.
• It would also involve the replacement of the connective tissue that binds the bones together with a screw.
• There might be a surgical option where there would be some adjustment made to the tissue that keeps your kneecap or patella centered.

According to a study conducted in 2015, it was noted that with surgical treatment of a bipartite patella, about 84.1% of participants experienced reduced pain, and 98.3% of them could return to their pre-surgery normal activity levels after they healed.

Bipartite patella remains an intriguing and uncommon anomaly of the knee. While many individuals with this condition may go through life without ever realizing its presence, it holds the potential to cause significant discomfort for some. The journey from its development to potential treatments has been thoroughly explored in this article. Whether it’s through non-invasive methods such as rest, ice, and physical therapy or the more intensive surgical interventions, there are several ways to manage and treat the symptoms associated with this condition. If you suspect you might have a bipartite patella or are experiencing knee discomfort, consulting a medical professional is paramount. They can guide you to an accurate diagnosis and recommend an optimal treatment strategy tailored to your needs. After all, understanding one’s body and staying informed is the first step towards optimal health.

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Also Read:

• Bipartite Patella: Causes, Symptoms, Treatment, Recovery Period
• Bipartite Patella in Athletes : Impact on Performance, Injury Risk, and Effective Treatments