Skip to main content
Log in

Clinical features and classification of bipartite or tripartite patella

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

The purposes of this study were to report clinical features of the developmental anomaly of ossification type bipartite or tripartite patella using a large series and to propose a new classification for the developmental anomaly of ossification type bipartite or tripartite patella. The first author prospectively examined 111 patients with symptomatic or asymptomatic bipartite (131 knees) or tripartite (8 knees) patellae. Eighty-six (77%) were male and 25 (23%) were female. Forty-three patients (39%) showed right knee involvement and 40 (36%) showed left, while 28 (25%) showed involvement in both knees. Forty-six bipartite and 4 tripartite patellae (36%) were symptomatic and 85 bipartite and 4 tripartite patellae (64%) were asymptomatic at initial examination. The median age at onset of pain of symptomatic patients (50 knees) was 15.6 ± 8.1 years (range, 10–51 years). The most common symptom was pain at the separated fragments during or after strenuous activity in all 50 knees. Physical examination revealed localized tenderness over the separated fragments in all 50 knees. Bipartite or tripartite patellae were classified by evaluating location and number of fragments. One hundred fifteen knees (83%) were classified as supero-lateral bipartite type, 16 (12%) were lateral bipartite type, 6 (4%) were supero-lateral and lateral tripartite type, and 2 (1%) were supero-lateral tripartite type. For the developmental anomaly of ossification type bipartite or tripartite patella, a classification based on both location and number of fragments is simple and easy to understand and applicable to all types of bipartite or tripartite patella.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Adachi N, Ochi M, Yamaguchi H, Uchio Y, Kuriwaka M (2002) Vastus lateralis release for painful bipartite patella. Arthroscopy 18:404–411

    Article  PubMed  Google Scholar 

  2. Adams JD, Leonard RD (1925) A developmental anomaly of the patella frequently diagnosed as fracture. Surg Gynecol Obstet 41:601–604

    Google Scholar 

  3. Bourne MH, Bianco AJ (1990) Bipartite patella in the adolescent: results of surgical excision. J Pediatr Orthop 10:69–73

    CAS  PubMed  Google Scholar 

  4. Canizares GH, Selesnick FH (2003) Bipartite patella fracture. Arthroscopy 19:215–217

    Article  PubMed  Google Scholar 

  5. Carter SR (1989) Traumatic separation of a bipartite patella. Injury 20:244

    Article  CAS  PubMed  Google Scholar 

  6. Enomoto H, Nagosi N, Okada E, Ota N, Iwabu S, Kamiishi S (2006) Hemilaterally symptomatic bipartite patella associated with bone erosions arising from a gouty tophus: a case report. Knee 13:474–477

    Article  PubMed  Google Scholar 

  7. George R (1935) Bilateral bipartite patellae. Br J Surg 22:555–560

    Article  Google Scholar 

  8. Green WT (1975) Painful bipartite patellae. Clin Orthop Relat Res 110:197–200

    Article  PubMed  Google Scholar 

  9. Gruber W (1883) In Bildungsanomalie mit Bildungshemmung begrundete Bipartition beider Patellae eines jungen Subjects. Arch pathol Ana 94:358–361

    Article  Google Scholar 

  10. Halpern AA, Hewitt O (1978) Painful medial bipartite patellae. A case report. Clin Orthop Relat Res 134:180–181

    PubMed  Google Scholar 

  11. Iossifidis A, Brueton RN (1995) Painful bipartite patella following injury. Injury 26:175–176

    Article  CAS  PubMed  Google Scholar 

  12. Ireland ML, Chang JL (1995) Acute fracture bipartite patella: case report and literature review. Med Sci Sports Exerc 27:299–302

    CAS  PubMed  Google Scholar 

  13. Ishikawa H, Sakurai A, Hirata S, Ohno O, Kita K, Sato T, Kashiwagi D (1994) Painful bipartite patella in young athletes. Clin Orthop Relat Res 305:223–228

    Article  PubMed  Google Scholar 

  14. Kanbe K, Nagase M, Kobuna Y, Kimura M (1993) Tophaceous gout of patella partite. J Rheumatol 20:1456–1457

    CAS  PubMed  Google Scholar 

  15. Kavanagh EC, Zoga A, Omar I, Ford S, Schweitzer M, Eustace S (2007) MRI findings in bipartite patellae. Skeletal Radiol 36:209–214

    Article  PubMed  Google Scholar 

  16. Kobayashi K, Deie M, Okuhara A, Adachi N, Yasumoto M, Ochi M (2005) Tophaceous gout in the bipartite patella with intra-osseous and intra-articular lesions: a case report. J Orthop Surg (Hong Kong) 13:199–202

    CAS  Google Scholar 

  17. Mori Y, Okuno H, Iketani H, Kuroki Y (1995) Efficacy of lateral retinacular release for painful bipartite patella. Am J Sports Med 23:13–18

    Article  CAS  PubMed  Google Scholar 

  18. Ogata K (1994) Painful bipartite patella. A new approach to operative treatment. J Bone Joint Surg Am 76:573–578

    CAS  PubMed  Google Scholar 

  19. Ogden JA, McCarthy SM, Jokl P (1982) The painful bipartite patella. J Pediatr Orthop 2:263–269

    CAS  PubMed  Google Scholar 

  20. Ogden JA (1984) Radiology of postnatal skeletal development. X. Patella and tibial tuberosity. Skeletal Radiol 11:246–257

    Article  CAS  PubMed  Google Scholar 

  21. Okuno H, Sugita T, Kawamata T, Ohnuma M, Yamada N, Yoshizumi Y (2004) Traumatic separation of a Type 1 bipartite patella. Clin Orthop Relat Res 420:257–260

    Article  PubMed  Google Scholar 

  22. Oohashi Y, Noriki S, Koshino T, Fukuda M (2006) Histopathological abnormalities in painful bipartite patellae in adolescents. Knee 13:189–193

    Article  PubMed  Google Scholar 

  23. Oohashi Y, Koshino T (2007) Bone scintigraphy in patients with bipartite patella. Knee Surg Traumatol Arthrosc 15:1395–1399

    Article  Google Scholar 

  24. Puddu G, Mariani P, Alzani R (1978) Detachment of the accessory fragment in “patella partite”. Ital J Orthop Traumatol 4:197–203

    CAS  PubMed  Google Scholar 

  25. Reber P, Crevoisier X, Noesberger B (1996) Unusual localization of tophaceous gout. A report of four patients and review of the literature. Arch Orthop Trauma Surg 115:297–299

    Article  CAS  PubMed  Google Scholar 

  26. Rosenthal RK, Levine DB (1977) Fragmentation of the distal pole of the patella in spastic cerebral palsy. J Bone Joint Surg Am 59-A:934–939

    Google Scholar 

  27. Saupe E (1921) Beitrag zur patella bipartita. Fortschr Rontgenstr 28:37–41

    Google Scholar 

  28. Sinding-Larsen MF (1921) A hitherto unknown affection of the patella in children. Acta Radiol 1:171–173

    Article  Google Scholar 

  29. Tashiro S, Sugita T, Nakamura S, Kurata Y (2002) Gout tophus in the bipartite patella. Orthopedics 25:1295–1296

    PubMed  Google Scholar 

  30. Thomas AL, Wilson RH, Thompson TL (2007) Quadriceps avulsion through a bipartite patella. Orthopedics 30:491–492

    PubMed  Google Scholar 

  31. Todd TW, McCally WC (1921) Defects of the patellar border. Ann Surg 14:775–782

    Article  Google Scholar 

  32. Tonotsuka H, Yamamoto Y (2008) Separation of a bipartite patella combined with quadriceps tendon rupture: a case report. Knee 15:64–67

    Article  PubMed  Google Scholar 

  33. Weaver JK (1977) Bipartite patellae as a cause of disability in the athlete. Am J Sports Med 5:137–143

    Article  CAS  PubMed  Google Scholar 

  34. Weckström M, Parviainen M, Pihlajamäki HK (2008) Excision of painful bipartite patella. Good long-term outcome in young adults. Clin Orthop Relat Res 466:2848–2855

    Article  PubMed  Google Scholar 

  35. Woods GW, O’Connor DP, Elkousy HA (2007) Quadriceps tendon rupture through a superolateral bipartite patella. J Knee Surg 20:293–295

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yoshikazu Oohashi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oohashi, Y., Koshino, T. & Oohashi, Y. Clinical features and classification of bipartite or tripartite patella. Knee Surg Sports Traumatol Arthrosc 18, 1465–1469 (2010). https://doi.org/10.1007/s00167-010-1047-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-010-1047-y

Keywords

Navigation