Bipartate Patella

• usually asymptomatic,  incidence 2%
• The accessory portion is on the superolateral pole (Saupe classification Type III) in 75% of bipartite patellas, on the lateral margin (Type II) in 20% and the inferior pole (Type I) in 5%

Bipartate Patella Clinical Evaluation

• Usually asymptomatic
• Symptomatic cases are generally  young athletes with pain exacerbated by increased sports activity.
• peripatellar knee pain with tenderness reproduced by palpation at the proximal lateral corner of the patella. No trauma.
• Trauma can cause the fragment to separate through a fibrous union.

Bipartate Patella Xray

• A/p lat and sunrise views of knee
• If separation has occurred after trauma the space between the fragments will increase in the squatting position (get skyline view in squatting position)
• Bone scan will be positive for recent fracture

Bipartate Patella Treatment

• No treatment needed if asymptomatic
• Activity restrictions, quadriceps strengthening exercises, and oral nonsteroidal anti-inflammatory drugs. 
• Consider bracing or immobilization in refractory cases
• Lateral retinacular release if non-op treatment fails. (Mori Y,Am J Sports Med 1995;23:13-18)
• Small fragments can be excised. (Bourne MK,  J Pediat Orthop 1990;10: 69-73)