Ongoing Frontal Knee Pain - Bipartite Patella Fracture

By Tomás Ryan BSc.AHS,Ph.Th. MIAPT, Registered Physical Therapist based in Thurles

Persistent ongoing pain at the front of the knee joint may be caused by an injury known as a Bipartite patella. A Bipartite Patella occurs when a fragment of bone becomes separated from the base of the patella bone otherwise known as the kneecap. The fragment of bone is connected to the base of the patella by fibrocartilage material. It is a commonly a symptomless condition of the kneecap that exists from birth. However trauma to the knee in the form of an impact injury or a subluxation (where the knee cap momentarily is dislocated from its groove), can disrupt and damage the fibro-cartilage bridge between the fragment of bone and the knee cap.

This is followed by continued frontal knee pain when walking, climbing stairs and driving. During all these activities the patella tendon which sits below the knee has a traction-like pull on the base of the patella when the knee joint bends and straightens. As the fragment of bone sits between base of the patella and the tendon it is constantly under stress due to this traction pull during knee movement, hence it cannot heel and gives a painful response during movement. The injury because it is uncommon is diagnosed incorrectly as patella tendinopathy in most instances, however no improvement to early stage rehabilitation exercises should suggest a Bipartite Patella Disruption injury. It is further verified by MRI examination.

Symptoms of a Bipartite patella Disruption Injury

• Pain at the front of the knee when

• Climbing Stairs

• Walking, Driving, squatting down into a crouched position

• Localised tenderness at base of kneecap

• Patient may have associated shin splints

• No improvement or reduction in pain after simple isometric knee extension exercises

• Particle of bone separated from base of patella on MRI scan

Treatment & Management

Initial treatment includes rest and elevation, ultrasound, anti-inflammatory medication and the use of crutches to aid healing. However if the symptoms continue to persist after a 6 month duration then surgery is required, which can involve removing the painful fragment of bone. The patient will use crutches for2-4 days post surgery followed by progressive exercise rehabilitation with research showing the return to sporting activities between 5-8 weeks post surgery.

Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles. Contact Number: 0504 26672