Return to activity among athletes with a symptomatic bipartite patella: A systematic review

• Surgical interventions for a symptomatic bipartite patella have a high success rate at returning athletes to their respective sports, but vary by procedure.
• Excision of the painful accessory fragment is the most common surgical intervention used, and produces the largest amount of success in returning athletes to sport without residual symptoms.
• The decision for surgical intervention, especially excision of the painful fragment, should come sooner in the surgeon’s treatment algorithm for athletes who fail conservative options initially.

BackgroundA bipartite patella is typically rare, but can become symptomatic during overuse activities such as those performed during athletic events. Therefore, this anomaly typically presents in the young, athletic population, often inhibiting athletic activities. Multiple treatment options exist, with nonsurgical management frequently adopted as the initial treatment of choice.PurposeTo determine the most effective intervention in returning athletes with symptomatic bipartite patella to their prior activity levels.MethodsA systematic review of the literature was performed using PRISMA guidelines to identify studies reporting outcomes of athletes' ability to return to activity following treatment for a symptomatic bipartite patella. The type of intervention, type of bipartite classification, outcomes, and complications were recorded.ResultsTwenty articles with a total of 125 patients and 130 knees were identified and included in this review. A total of 105 athletes made a full return to athletic activity following treatment for their painful bipartite patella. One hundred athletes (85.5%) that underwent surgical treatment were able to make a full return to their sport without symptoms, although this varied by surgical procedure performed. Excision of the painful fragment produced the best results in returning athletes to sport, with 91% returning without symptoms and nine percent returning but with residual symptoms.ConclusionSurgical treatments for symptomatic bipartite patellae are successful at returning athletes to their same level of play, and best outcomes are with excision of the fragment. These results are limited, however, due to the poor quality of original data given the rarity of the anomaly and the underrepresented conservative treatment group.