Letter to the Editor: Approaches to the treatment management of symptomatic bipartite patella

Dear Editor,

We read with great interest the recent systematic review on the management of symptomatic bipartite patella in pediatric and adolescent populations. While the presented evidence-based treatment algorithm offers valuable insights into the management of this condition, we believe there are additional points to consider based on findings from adult cases and the broader literature.

As highlighted in numerous studies, bipartite patella is often asymptomatic but can cause significant anterior knee pain in some cases. Conservative treatment is typically the first-line approach, with surgical intervention reserved for refractory cases. Interestingly, a case report involving a 26-year-old patient demonstrated complete symptomatic relief following fragment excision, highlighting the potential efficacy of surgical treatment in adult populations with greater biomechanical recovery capacity. ¹

Another approach in adult cases involves the use of local anesthetic injections around the bipartite fragment to predict surgical outcomes. This technique holds promise for optimizing treatment strategies before proceeding to surgery. Although data on the use of this approach in pediatric populations remain insufficient, it may offer a valuable strategy for expediting treatment planning in younger patients. ²

Furthermore, various surgical techniques, including fragment excision, lateral release, and fixation, have been reported to yield good outcomes. The size and location of the bipartite fragment play a crucial role in determining the appropriate surgical procedure. This observation, supported by the current literature,^{1 –4} underscores the importance of individualized treatment plans. More studies are warranted to explore the impact of these factors on outcomes in pediatric cases.

Minimally invasive techniques, such as ultrasound-guided injections and fenestration, are also gaining interest as alternatives to more invasive surgical approaches. In a study by Nakase et al., ⁵ ultrasound-guided injections and the pie-crust technique were proposed as potential alternative treatments for symptom relief in adults. While data on these techniques in pediatric populations are limited, they could serve as valuable alternatives for young patients where preserving patellar integrity is paramount.

In conclusion, the management of symptomatic bipartite patella remains a complex and multifaceted challenge. Integrating insights from adult cases with pediatric-focused research could further enhance treatment algorithms and broaden their applicability. Combining data from both populations may lead to a more comprehensive understanding of this condition and ultimately improve patient outcomes.

Supplemental Material

sj-pdf-1-cho-10.1177_18632521251330820 – Supplemental material for Letter to the Editor: Approaches to the treatment management of symptomatic bipartite patella

Supplemental material, sj-pdf-1-cho-10.1177_18632521251330820 for Letter to the Editor: Approaches to the treatment management of symptomatic bipartite patella by Murat Yuncu, Omer Faruk Egerci and Fırat Dogruoz in Journal of Children’s Orthopaedics