P0184 - Outcomes of Surgical Treatment of Symptomatic Bipartite Patella in Teenage Athletes

Introduction
Bipartite patella affects about 2-3% of people. Most cases are asymptomatic; however, some teenage athletes with bipartite patella develop anterior knee pain due to fragment mobility. The bipartite patella is connected to the primary patella by fibrocartilage. The fibrous attachment can become separated by sports activity and trauma. When conservative therapy fails (PT, icing, bracing, NSAIDs), surgery is indicated. The purpose of this study is to report the outcomes of fragment excision and/or lateral release in teenage athletes with symptomatic bipartite patella.

Methods
The study was approved by the College of Medicine IRB. A retrospective chart and radiograph review was performed on patients that underwent surgery for bipartite patella over a 10 year period. Patients were excluded if age > 18, a history of prior knee fracture or knee surgery. Data collected included: age, gender, BMI, sports played, complaints, physical exam findings, conservative measures attempted, radiographic Saupe classification, radiographic size of the fragment as a % of the entire patella, status of the physis, use of advanced imaging, surgical treatment, duration of follow up, return to sports, Lysholm score and post-operative complications.

Results
Six teenage patients were studied. The average age was 15.8 years. Three were male and 3 were female. The average BMI was 23.3. Sports played included basketball (3), cheer (1), football (2), track (1), and soccer (1). Two patients played multiple sports. All 6 complained of anterior knee pain exacerbated by sports. Five had tenderness to palpation directly over the site of the bony division. All patients had failed > 6 months of conservative treatment including: therapy, bracing, taping, icing, and NSAIDs. Saupe classification included: 5 type III (superolateral) and 1 type II (lateral). Four had closed growth plates. The radiographic size of the fragment averaged 7% of the size of the patella. Three patients had an MRI. Surgical treatment included: 1 arthroscopic lateral release, 2 open excisions, and 3 arthroscopic assisted open excision and lateral releases. The duration of follow up averaged 21 weeks (range 8-48 weeks). All patients returned to pre surgery sports at an average of 6 weeks post op. The average Lysholm score at final follow-up was 96 (range 92-100). One complication occurred during the follow-up period. A 16-year-old male football player developed a post-op wound infection 7 days after open excision and resection of the accessory fragment. He was successfully treated with Irrigation and Debridement and 2 weeks of antibiotics. He returned to sports without symptoms at 6 weeks.

Conclusion
Symptomatic bipartite patella is an uncommon cause of anterior knee pain in adolescent athletes. When pain persists despite conservative care, fragment excision and/or lateral release resulted in excellent pain relief and return to full sporting activity in all cases.