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Conservative versus surgical management of pediatric bipartite patella with patellar dislocation: a single-center
Xipeng Wang1, Kun Nie1, Jiangtao Liu1
1Department of Orthopedic Surgery, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Surgical management for pediatric bipartite patella (BP) with patellar dislocation offers superior functional recovery and pain relief compared to conservative treatment. This approach also significantly reduces recurrence rates, indicating better long-term outcomes for affected children.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Sports medicine
Background:
- Congenital bipartite patella (BP) with patellar dislocation presents a challenge in pediatric orthopedic management.
- Evaluating clinical features and comparing treatment outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To compare the clinical features and outcomes of conservative versus surgical management in pediatric patients diagnosed with bipartite patella (BP) and patellar dislocation.
- To assess functional recovery, pain levels, and recurrence rates between the two treatment groups.
Main Methods:
- A retrospective study included 42 pediatric patients (≤16 years) with BP and patellar dislocation treated between January 2019 and January 2024.
- Patients were divided into conservative (n=18) and surgical (n=24) groups, with surgical intervention involving lateral retinacular release, MPFL reconstruction, and optional internal fixation.
- Functional outcomes were evaluated using Lysholm, Kujala, and VAS scores, alongside radiological parameters and complication/recurrence rates.
Main Results:
- Both groups showed significant functional improvement, but the surgical group exhibited superior outcomes in Lysholm, Kujala, and VAS scores (P<0.001).
- Surgical management led to normalized patellofemoral alignment and solid bony union in cases with internal fixation.
- Recurrence rates were 27.8% in the conservative group versus 0% in the surgical group, with no major complications reported.
Conclusions:
- Surgical management, including MPFL reconstruction and lateral retinacular release, provides superior functional recovery, pain relief, and lower recurrence rates in pediatric BP with patellar dislocation compared to conservative therapy.
- This study suggests that surgical intervention may be the preferred approach for selected pediatric patients experiencing bipartite patella with patellar dislocation.
Objective:
To evaluate clinical features and compare outcomes of conservative vs. surgical management in pediatric patients with congenital bipartite patella (BP) and patellar dislocation.
Methods:
A retrospective study included 42 children (≤16 years) with BP and patellar dislocation treated between January 2019 and January 2024. Patients received either conservative treatment (n = 18; reduction, immobilization, and rehabilitation) or surgical treatment [n = 24; lateral retinacular release, medial patellofemoral ligament (MPFL) reconstruction, ± internal fixation of accessory fragments]. Functional outcomes were assessed using Lysholm, Kujala, and visual analog scale (VAS) scores preoperatively and at final follow-up. Radiological parameters included patellar congruence angle, tibial tubercle-trochlear groove distance, and accessory fragment healing. Complications and recurrence rates were recorded.
Results:
Baseline characteristics were comparable, except for a higher proportion of having suffering recurrent dislocations in the surgical group (P = 0.001). Both groups improved significantly in functional scores (P < 0.05), but the surgical group demonstrated superior outcomes (Lysholm: 90.5 ± 4.8 vs. 76.3 ± 8.1; Kujala: 92.1 ± 3.9 vs. 78.9 ± 7.5; VAS: 1.2 ± 0.9 vs. 3.1 ± 1.4; P < 0.001). Surgical patients achieved normalization of patellofemoral alignment, and all eight patients undergoing internal fixation achieved solid bony union. Recurrence occurred in 27.8% of conservatively treated patients but in none of the surgical group. No major complications were reported.
Conclusion:
In pediatric BP with patellar dislocation, surgical management combining MPFL reconstruction and lateral retinacular release, with selective internal fixation, provides superior functional recovery, pain relief, and lower recurrence compared to conservative therapy, suggesting that surgical management may provide superior outcomes in selected pediatric patients.
