The Management of Patella Stress Fractures and the Symptomatic Bipartite Patella

Stress fractures of the patella are uncommon. If patellae displace, operative treatment and prolonged rehabilitation will be required and, therefore, a high degree of suspicion is needed. Patients typically report activity-related pain (as a result of an initial stress response) and then subsequently sustain a fatigue stress fracture after minor trauma. In cases where the patella has been previously weakened, such as after patella resurfacing, the term insufficiency stress fracture is used. Diagnosis is made with radiographs and a bone scan and MRI when necessary. Treatment is based on the extent of the fracture, whether complete or incomplete, and the displacement. Incomplete fractures or a stress response may be treated with activity modification alone, complete undisplaced fractures require immobilization until healing occurs, and displaced fractures should have operative reduction and internal fixation to restore natural biomechanics. The symptomatic bipartite patella may also present with anterior knee pain. Those that fail nonoperative measures may require surgical excision. Overall, patients can be expected to make a full recovery and return to preinjury levels of activity.