Treatment of symptomatic bipartite patella in patients <21 years of age: A systematic review and treatment algorithm

Purpose: The purpose of this study is to develop an evidence-based algorithm for the management of symptomatic bipartite patella in the pediatric and adolescent population based on a systemic review of the published literature.

Methods: A systematic review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines on PubMed and Embase, selecting for studies discussing the management of symptomatic bipartite patella.

Results: Five studies met criteria, involving 315 knees (314 patients, average age 15.8 years). All patients presented with symptomatic bipartite patella and underwent an initial trial of conservative management. Seventy-six percent (239 knees) achieved full resolution of symptoms after conservative management at a median of 1.9 months. The remaining 76 knees (24.12%) had persistent symptoms requiring operative intervention. Surgical techniques included surgical excision, screw fixation, synchondrosis drilling, lateral release, and both arthroscopic and open interventions (92.1%). Most patients (90.79%) who underwent surgical intervention had partial or complete resolution of their symptoms. Seven of 76 knees (9.21%) needed management postoperatively for pain due to trauma, residual symptomatic ossicles, and hardware complications. Of these, four patients required reoperations (average 2 years). The remaining three patients had satisfactory outcomes with an additional course of conservative management and oral analgesics.

Conclusion: Management of symptomatic bipartite patella should begin with a trial of conservative management. With refractory symptoms lasting greater than 3 months, surgical intervention may be considered with positive outcomes of partial or complete resolution of symptoms. The proposed algorithm is provided to guide physician management of symptomatic BPP in pediatric or adolescent patients.