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child's knee pain-bipartite patella.

Hi there. Just wondering if anyone has had any experience with a bipartite patella. My 13 year old son was just diagnosed by the orthopedic dr yesterday after 2 years of intermittant right knee pain. His pediatricain thought that it was osgood schlatter's, but after an x-ray, it was obvious.His knee-cap is in 2 pieces, a smaller one on the outer part of the knee-cap and the main knee-cap. What worked for you? They are suggesting a complete cast from hip to heel for 6 weeks to "settle" it down. Then, surgery to remove the smaller separate bone if this doesn't help the pain. I'd love to hear your stories. Thank you in advance.
10 Responses
Avatar universal
I have a bipartite patella and have patellae tracking trouble because of it.  All conservative therapy related to strengthening to improve his pain should be done before surgery.  I don't believe it is thought that pain in the knee is usually directly caused by the bipartite bone itself but more due to tracking trouble.  
Avatar universal
SURGERY SHOULD BE A LAST RESORT.I am 48 and discoverd i had this condition when i was about 16.I have had  some knee issues over the yrs,but nothing really significant.I have also been a very athletic person my whole life,including sports such as baseball,hockey,and i was a national high school wrestler.My sugestion to you would be to keep your son flexable and strong.Their approach is way to radical for someone with intermitant pain,as that is what i experienced over my entire life.I just read an article on this type of approach,this is how i found you,and the prognosis was not very positve.It could take 5 yrs. for a 70% recovery,if your son is active this could be very frustating for him and very costly to you for rehab.
Avatar universal
i was about 13-14 years old + was extremely active, playing football, basketball + rugby for teams + engaging in other activities with my friends.i then developed  severe pain in my knee. docs said i had broken my kneecap + put me in plaster for 6 weeks. after the plaster was removed it still gave me pain. i then had an injection in my kneecap +  the pain subsided. im now 29 years old + the pain has returned with a vengeance. had xray + have now after this long been diagnosed with bipartite patella. where i go from here i dont know. was wondering what came of your sons bipartite patella?
Avatar universal
I am 15 years old. I was diagnosed with bipartite patella a year ago.
During that year i was in alot of pain, since i play soccer and basketball. In soccer you run alot, and i did run alot. I never got put on the bench, but i was in so much pain. There really is nothing you can do about it besides surgery. I am getting surgery done on it, and i am happy that the pain will be gone.
Hi, I am not sure if you are still on this forum, but curious if you had fixation surgery?  If so, did it work and what is the rehab like?
Dunks, How are you doing now?  Did surgery help?
Avatar universal
My 12-year-old son was diagnosed with this just a week or so ago.  He had taken a hard hit on the basketball court a couple months ago, and the pain never really went away. They thought he had a cracked patella, but the xray showed the bipartite. He's a year-round athlete, and what I'm hearing is that removing the smaller piece is the only way to get any relief. We're headed for a bone scan next week, and then a second opinion, but all my research is pointing toward surgery in the next few weeks. From what I can tell, nothing short of that is going to relieve the pain enough to play basketball or baseball again. What I've mostly come up with is that, if he hadn't sustained an injury directly to the kneecap (they think the smaller piece is actually fractured), he may never have known he had this condition in the first place. But once it's injured, the pain won't abate until the piece is removed. Best of luck to both our sons..
Hi Amy,  Are you still on this forum?   If so, I would like to talk with you about your son's treatment, etc.  My son has this too and his bipartite appears too large for excision.   Maybe fixation surgery.  he is a basketball player and wants to get back on the court.   any thoughts or counsel would help!
Avatar universal
I wouldn't hurry into surgery.  I fell off the top of a bunk bed and landed on a suitcase when I was 12.  My knee became very swollen, water of the knee and the xrays then showed the bipartitie patellae.  It healed fine then.  It is now years later I have trouble related to other biomechanical issues ie toed in gait, medial condyle cartilage fracture.  The patellea is shaped like a triangle with rounded corners.  The exta bone in one corner make the patellae more weighted there effecting patellae tracking.  Changing the shape of the patellae by removing it just creates a different shape patellae and I don't know if that will make it track better which is why it isn't clear to me if you will improve anything.

A parallel but different example is I had a lateral release on the retinaculum (fibrous tissue that helps hold the patellae in place) 13 years ago.  The ortho told me my patellae would track so much better after he did that.  It has been a disaster, by releasing the tissue that was actually stabilizing my patellae, it allow it to track all over and it took years for that to improve.

Surgery is always, I repeat always a last resort unless something is broken and cannot be repaired anyother way.  

Avatar universal
I started having bad knee pain in middleschool which seriously effected my track times.  I went to the trainer and he said it was just runner's knee and that with rest the pain would go away.  But it didn't.  So I went to the othopedist and got x-rayed.  I had a bi-partate patella (the lump on my knee from it is obvious).  The first plan of action was 6 weeks with no activity.  It prooved to no avail.  So I went to physical therapy for three months.  It seemed to do nothing.  Now I'm running highscool track and the pain is worse than ever, it hurts just to walk in school, going up and down stairs, lifting my leg straight if I'm sitting, and especially during running.  I have researched surgery for it and it sounds like it would help alot.  But my parents are cheap and eventhough I was one of the best middleschool runners in the state theyd rather have me not run than pay for the surgery.  I would Just like to say for all of you who have or will get the surgery how lucky you are because this pain *****.
Avatar universal
Hi, I'm 14 and I run extremely competitive cross country and track year-round. After persistant knee pain, I went to an orthopedic. I got an x-ray and it showed that I have a bipartite patella. I went to Physical Therapy and did strengthening excersises and lots of stretching (illotibial band & quads). I also iced my knee for 20 minutes when I got home. Then, before I go to bed I took some sort of NSAID.(Motrin, Ibuprofen) Most of the pain is gone now and hopefully soon completely gone.

Here is my advice in a nutshell...
Hi, thanks for your advice.
Avatar universal
Damn I'm not sure if any of you are still checking this thread but I recently found out I have the same issue going on. I was on my moped and was hit by a car a little less than a month ago and after xray, they showed me it was not a fractured patella like they originally thought, it was bipartite patella. well after 3 weeks of being immobalized, which just made my quad atrophy like crazy and make me insanely weak in the leg, I'm told to start pt. Some of your stories say that the surgery was not so good and others praise it. Im trying to do as much research as I can and the case studies I've come across seem to say that the best surgery methods are an arthroscopy or a release. I want to get a new ortho because he even brought up pins and screws.. SERIOUSLY? PINS AND SCREWS??! I don't think so as the research I read pretty much says theyre overboard for this and dont have the best recovery times/prognosis. Anyway, I'm going to start pt and hope it helps. one study showed that 2 kids were able to achieve fusion of the two patella pieces after 2 months of ultrasound. *crosses fingers*. I used to play ball all the time and was finally getting all of my quickness back and elevation on my jumpshot. FUDGE. hope everyone has healed up ok and if you guys can, can u post up ur current results thanks!!
Hi, are you still checking this forum?   If so, what has happened since 2011?   My son was just diagnosed with this as well and we are looking at all options.  He has had patellar tendonitis symptoms for about 9 months now.
Avatar universal
My 12 year old son was just diagnosed with bipartite patella after having pain in his left knee which began after a minor traumatic fall on it a  year ago.  Luckily our family doctor ordered x-rays and our chiropractor ordered a CT scan to review the injury carefully and referred us to a specialist.  We took him to see an orthopedic surgeon in Stanford University's Children's Clinic.  Her advice was PT first.  A knee brace with patella support is not necessary unless it gives him relief while playing.  She said he could continue sports as long as it wasn't too painful for him to play.  If after two months of PT, the pain doesn't improve or gets worse, then we'll go back for surgery (removal of the piece) and avoid sports for about 2 months while it heals.  This sounds like a sensible plan so far.
Hi, are you still on this forum?   I'm curious what has happened so far, given that as 6 years ago.  Did you son get the surgery?  
My son had a fall last summer and was diagnosed with a bone bruise and they also indicated at the time (but never told us) that there was an atypical bipartite patella.  His knee recently gave way and now we are back at Orthopedic surgeon - have seen knee doc and pediatric ortho.  One says surgery fixation and other says conservative treatment first.  
Did you have surgery?  How are things going?
cstevenmort-----  are you contemplating the fixation surgery?
No, my son had the fragment taken out.  It’s been 5 months.  He has sharp pain still on other side of patella.   Not sure if this is a result of the surgery.  But it’s been very frustrating.   He still can even jog yet or the sharp pain will happen within a minute of jogging.  
He doesn’t have the same pain from when he had the Bipartite pain where the fragment was.   It’s on inner side of patella.
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