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Sasaki R, Nagashima M, Tanaka K, Okada Y, Komatsu S, Takeshima K. Accessory fragment migration in a professional baseball player with bipartite patella: A case report. Int J Surg Case Rep 2023; 112:108933. [PMID: 37856973 PMCID: PMC10667769 DOI: 10.1016/j.ijscr.2023.108933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Bipartite patella (BP) is usually recognized as an incidental radiographic finding. Therefore, no reports have observed the process of accessory fragment migration. We present the case of a professional baseball pitcher with significant migration of the fragment during follow-up. PRESENTATION OF CASE A 26-year-old man was diagnosed with symptomatic BP and underwent conservative therapy. Eleven months later, he was unable to play baseball because of gradually worsening knee pain without obvious trauma. On radiographs, the accessory fragment which had located at the superolateral pole 11 months earlier migrated posterolaterally. The diagnosis of Saupe's type III BP was established, and open excision of the accessory fragment was performed. Postoperatively, full-weight-bearing walking and range-of-motion exercises were started the day after surgery. Three months after surgery, he could pitch with all his power without pain. DISCUSSION Since our patient was a professional baseball right-handed pitcher who needed to step strongly on his left knee during pitching, strong traction force from the vastus lateralis was likely to have been repeatedly applied to the accessory fragment. It might lead to migration of the accessory fragment. The open excision of the accessory fragment was performed because the accessory fragment had migrated away from the patella body. CONCLUSION We report a case of professional baseball player with symptomatic BP, in which case the chronological migration of the accessory fragment was observed without obvious trauma. When the accessory fragment is identified without obvious trauma, one of the differential diseases could be a BP.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan; Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita city, Chiba 286-8686, Japan
| | - Masaki Nagashima
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan; Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita city, Chiba 286-8686, Japan.
| | - Kentaro Tanaka
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan; Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita city, Chiba 286-8686, Japan
| | - Yoshifumi Okada
- Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Shuro Komatsu
- Institute for Integrated Sports Medicine, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8642, Japan
| | - Kenichiro Takeshima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 4-3 Kōzunomori, Narita city, Chiba 286-8686, Japan; Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita city, Chiba 286-8520, Japan
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Kraus E, Rizzone K, Walker M, Brown N, Kaur J, Magrini D, Glover J, Nussbaum E. Stress Injuries of the Knee. Clin Sports Med 2022; 41:707-727. [DOI: 10.1016/j.csm.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Bipartite patella affects about 2% of people. Most cases are asymptomatic; however, some develop anterior knee pain during sports. When conservative treatment fails, surgery can be considered. This study reports the outcomes of fragment excision with or without lateral release in teenage athletes with symptomatic bipartite patella. The study was approved by the College of Medicine Institutional Review Board. A retrospective review was performed. Patients were excluded if age >18 or had prior knee surgery. Data collected included age, gender, BMI, sports played, Saupe classification, conservative and surgical treatment, advanced imaging used, duration of follow-up, Lysholm Score and postoperative complications. Five teenage patients were studied. The average age was 15.6 years and BMI was 23. Sports played included basketball, football, track-and-field and soccer. All patients complained of anterior knee pain exacerbated by sports. All patients failed >6 months of conservative treatment. Saupe classification included four type III (superolateral) and one type II (lateral). Two patients had an MRI. Surgical treatment included two open excisions and three arthroscopic-assisted open excisions with lateral releases. The average Lysholm Score was 97. Postoperatively, all patients returned to presurgery sporting activity at an average of 9.8 weeks (range, 6-13 weeks). A 16-year-old male treated by open excision developed a postoperative wound infection. He was successfully treated with irrigation & debridement and antibiotics and returned to sports at 6 weeks. Symptomatic bipartite patella is an uncommon cause of anterior knee pain in adolescent athletes. When pain persists despite conservative care, fragment excision with or without lateral release resulted in excellent pain relief and return to full sporting activity in all cases.
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Zerouali Boukhal Z, Belgadir H, Jadib A, Amriss O, Adam Fadoul A, Merzem A, Moussali N, El Benna N. Painful bipartite patella following injury: a case report. Radiol Case Rep 2022; 17:725-728. [PMID: 35003469 PMCID: PMC8717434 DOI: 10.1016/j.radcr.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022] Open
Abstract
Bipartite patella is a normal variation in ossification development. This variation is usually asymptomatic but can cause persistent and debilitating anterior knee pain with an injury. We report the case of a 56-year-old man complaining of persistent anterior left knee pain following trauma. Standard knee radiographs show a bilateral Bipartite Patella appearance, and magnetic resonance imaging shows discrete bony edema of the cancellous bone of the accessory bone and about the synchondrosis explaining the anterior knee pain, associated with a crack in the posterior compartment of the medial meniscus. Conservative care including medical treatment with non-steroidal anti-inflammatory drugs, physical therapy was used. Magnetic resonance imaging is the most valuable diagnostic tool for evaluating detailed morphologic and pathologic changes in patients with the bipartite patella.
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Affiliation(s)
- Zineb Zerouali Boukhal
- Radiology Department August 20, Ibn Rochd University Hospital Center, Faculty of Medicine and Pharmacy of Casablanca, 6 Rue Lahcen Al Aarjoune, Casablanca 20250, Morocco
| | - Hasna Belgadir
- Radiology Department August 20, Ibn Rochd University Hospital Center, Faculty of Medicine and Pharmacy of Casablanca, 6 Rue Lahcen Al Aarjoune, Casablanca 20250, Morocco
| | - Abdelhamid Jadib
- Radiology Department August 20, Ibn Rochd University Hospital Center, Faculty of Medicine and Pharmacy of Casablanca, 6 Rue Lahcen Al Aarjoune, Casablanca 20250, Morocco
| | - Omar Amriss
- Radiology Department August 20, Ibn Rochd University Hospital Center, Faculty of Medicine and Pharmacy of Casablanca, 6 Rue Lahcen Al Aarjoune, Casablanca 20250, Morocco
| | - Achta Adam Fadoul
- Radiology Department August 20, Ibn Rochd University Hospital Center, Faculty of Medicine and Pharmacy of Casablanca, 6 Rue Lahcen Al Aarjoune, Casablanca 20250, Morocco
| | - Aicha Merzem
- Radiology Department August 20, Ibn Rochd University Hospital Center, Faculty of Medicine and Pharmacy of Casablanca, 6 Rue Lahcen Al Aarjoune, Casablanca 20250, Morocco
| | - Nadia Moussali
- Radiology Department August 20, Ibn Rochd University Hospital Center, Faculty of Medicine and Pharmacy of Casablanca, 6 Rue Lahcen Al Aarjoune, Casablanca 20250, Morocco
| | - Naima El Benna
- Radiology Department August 20, Ibn Rochd University Hospital Center, Faculty of Medicine and Pharmacy of Casablanca, 6 Rue Lahcen Al Aarjoune, Casablanca 20250, Morocco
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Floyd ER, Falaas KL, Carlson GB, Monson J, LaPrade RF. Arthroscopic Excision of Bipartite Patella. Arthrosc Tech 2021; 10:e1257-e1262. [PMID: 34141540 PMCID: PMC8185573 DOI: 10.1016/j.eats.2021.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023] Open
Abstract
A bipartite patella usually presents as an incidental finding on radiographs because most cases are asymptomatic. However, some patients may present with pain and functional limitations. Conservative treatment is sufficient to resolve symptoms in most cases; however, a small minority of patients may require surgical management. Recent studies have reported excellent results with an arthroscopic approach. This Technical Note details our procedure for treating a symptomatic bipartite patella that has not resolved with conservative care.
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Affiliation(s)
- Edward R. Floyd
- Twin Cities Orthopedics, Edina-Crosstown, Edina, Minnesota, U.S.A.,Georgetown University School of Medicine, Washington, DC, U.S.A
| | - Kari L. Falaas
- University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A
| | | | - Jill Monson
- TrainingHaus, Twin Cities Orthopedics, Eagan–Viking Lakes, Eagan, Minnesota, U.S.A
| | - Robert F. LaPrade
- Twin Cities Orthopedics, Edina-Crosstown, Edina, Minnesota, U.S.A.,Address correspondence to Robert F. LaPrade, M.D., Ph.D., Twin Cities Orthopedics, Edina-Crosstown, 4010 W 65th St, Edina, MN 55435 U.S.A.
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Nakase J, Oshima T, Takata Y, Shimozaki K, Asai K, Toyooka K, Tsuchiya H. Ultrasound-guided injection and the pie crust technique for the treatment of symptomatic bipartite patella. J Med Ultrason (2001) 2019; 46:497-502. [PMID: 31264048 DOI: 10.1007/s10396-019-00960-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/07/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to investigate the results of a new treatment procedure (ultrasound-guided injection and the "pie crust" technique for lengthening of capsular tendon structures) for symptomatic bipartite patella. METHODS We retrospectively investigated patient outcomes following the treatment of symptomatic type III bipartite patella with our new technique. Fifteen knees in 14 boys (mean age, 13.0 ± 1.7 years) were included. The procedure involved the injection of 1% lidocaine (2 mL) and triamcinolone acetonide (5 mg) between the patella and fragment. We then punctured 10 sites from one skin puncture to extend lateral capsular tendon structures. The patients were clinically assessed using the Victorian Institute of Sports Assessment (VISA) score before and 1 week, 1 month, and 3 months after the procedure. Patients were also evaluated for complications. RESULTS The average VISA score was 45.7 ± 4.7 before treatment, 70.6 ± 7.3 at 1 week post-treatment, 84.4 ± 16.6 at 1 month post-treatment, and 88.6 ± 18.3 at 3 months post-treatment. The VISA score improvement from before the procedure to 1 week after the procedure was significant (P < 0.01). There were no complications in any of the patients, who returned to sports at a mean of 4.2 ± 2.1 weeks after the procedure. However, two patients (three knees) had poor results and could not return to action; thus, they underwent surgical treatment 4 months after the ultrasonographic procedure. CONCLUSIONS This novel method is a potential treatment option for the management of symptomatic bipartite patella in outpatient clinics.
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Affiliation(s)
- Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
| | - Takeshi Oshima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Yasushi Takata
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Kengo Shimozaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Kazuki Asai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Kazu Toyooka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
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One Year of Knee Pain in a 21-Yr-Old Male Frisbee Player. Am J Phys Med Rehabil 2019; 99:e1-e2. [PMID: 30998521 DOI: 10.1097/phm.0000000000001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Felli L, Formica M, Lovisolo S, Capello AG, Alessio-Mazzola M. Clinical Outcome of Arthroscopic Lateral Retinacular Release for Symptomatic Bipartite Patella in Athletes. Arthroscopy 2018; 34:1550-1558. [PMID: 29456063 DOI: 10.1016/j.arthro.2017.11.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/26/2017] [Accepted: 11/17/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the results of arthroscopic lateral retinacular release without excision of the accessory fragment for treatment of symptomatic bipartite patella with a minimum 2-year follow-up. METHODS We retrospectively reviewed all cases of symptomatic type III bipartite patella confirmed by radiographs, computed tomography, and magnetic resonance imaging and treated with arthroscopic lateral release from 2005 to 2015. Patients with history of knee fractures or surgery, concomitant meniscal or anterior cruciate ligament (ACL) procedures, and severe arthritic changes of the patellofemoral joint were excluded. Patients were assessed by Kujala score, visual analog scale (VAS), Tegner Activity Scale (TAS), and time to return to sporting activities. RESULTS Ten patients (11 knees) were clinically reassessed after 69.6 ± 33.3 (range: 25-132; 95% confidence interval [CI]: 47.29-91.99) months from surgery. There was a significant improvement in Kujala (P < .05) and VAS scores (P < .05), and no differences were found between pre- and postoperative TAS scores (P > .05). No complications occurred during the follow-up period. All patients returned to sport after 42.3 ± 11.3 (range: 30-60; 95% CI: 34.71-49.84) days after surgery. CONCLUSIONS The arthroscopic lateral retinacular release of a symptomatic type III bipartite patella without excision of the accessory fragment allowed early return to sporting activities, with excellent symptom relief. Patients had significantly improved mean Kujala and VAS scores without a decrease in the mean TAS scores. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Lamberto Felli
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), IRCCS San Martino IST, Genova, Italy
| | - Matteo Formica
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), IRCCS San Martino IST, Genova, Italy
| | - Stefano Lovisolo
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), IRCCS San Martino IST, Genova, Italy
| | - Andrea Giorgio Capello
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), IRCCS San Martino IST, Genova, Italy
| | - Mattia Alessio-Mazzola
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), IRCCS San Martino IST, Genova, Italy.
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Ferrari MB, Sanchez A, Sanchez G, Schantz K, Ellera Gomes JL, Provencher MT. Arthroscopic Bony Resection for Treatment of Symptomatic Bipartite Patella. Arthrosc Tech 2017; 6:e1003-e1007. [PMID: 28970984 PMCID: PMC5621425 DOI: 10.1016/j.eats.2017.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/07/2017] [Indexed: 02/03/2023] Open
Abstract
Bipartite patella is a common pathology, affecting 2% to 3% of the population. Usually these cases are bilateral and asymptomatic. However, a patient with a bipartite patella may complain of pain, which is most likely related to fragment mobility. Conservative treatment with physiotherapy, immobilization, and nonsteroidal drugs are encouraged during the initial 6 months following diagnosis. This option is effective in most patients. For patients who do not improve with these conservative measures, surgical intervention is indicated. Many surgical treatment options have been described including excision of the fragment, as well as fixation. Fragment excision has demonstrated positive outcomes and is associated with an asymptomatic return to sport activities. The purpose of this Technical Note is to describe our preferred arthroscopic technique for the treatment of symptomatic bipartite patella.
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Affiliation(s)
| | | | - George Sanchez
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Katrina Schantz
- Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - João L. Ellera Gomes
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Matthew T. Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,Address correspondence to Matthew T. Provencher, M.D., Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657, U.S.A.Steadman Philippon Research Institute181 West Meadow DriveSuite 1000VailCO81657U.S.A.
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Patel DR, Villalobos A. Evaluation and management of knee pain in young athletes: overuse injuries of the knee. Transl Pediatr 2017; 6:190-198. [PMID: 28795010 PMCID: PMC5532199 DOI: 10.21037/tp.2017.04.05] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Recurrent or chronic activity related knee pain is common in young athletes. Numerous intrinsic conditions affecting the knee can cause such pain. In addition, knee pain can be referred pain from low back, hip or pelvic pathology. The most common cause of knee pain in young athletes is patellofemoral pain syndrome, or more appropriately termed idiopathic anterior knee pain. Although, numerous anatomical and biomechanical factors have been postulated to contribute the knee pain in young athletes, the most common underlying reason is overuse injury. In this paper, we have reviewed selected conditions that case knee pain in athletes, including anterior knee pain syndrome, Osgood-Schlatter disease, Sinding-Larsen-Johanssen syndrome, juvenile osteochondritis dissecans (JOCD), bipartite patella, plica syndrome, and tendonitis around the knee.
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Affiliation(s)
- Dilip R Patel
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan 49008, USA
| | - Ana Villalobos
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan 49008, USA
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