Hines Kristen E, Liu David S, Steele Amy E, Gabriel Daniel, Prabhat Anjali, Yen Yi-Meng, Hogue Grant Douglas
Harvard Medical School, Boston, MA, USA.
Harvard Combined Orthopaedic Residency Program, Boston, MA, USA.
J Child Orthop. 2024 Dec 24;19(1):75-82. doi: 10.1177/18632521241308410. eCollection 2025 Feb.
The purpose of this study is to develop an evidence-based algorithm for the management of symptomatic bipartite patella in the pediatric and adolescent population based on a systemic review of the published literature.
A systematic review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines on PubMed and Embase, selecting for studies discussing the management of symptomatic bipartite patella.
Five studies met criteria, involving 315 knees (314 patients, average age 15.8 years). All patients presented with symptomatic bipartite patella and underwent an initial trial of conservative management. Seventy-six percent (239 knees) achieved full resolution of symptoms after conservative management at a median of 1.9 months. The remaining 76 knees (24.12%) had persistent symptoms requiring operative intervention. Surgical techniques included surgical excision, screw fixation, synchondrosis drilling, lateral release, and both arthroscopic and open interventions (92.1%). Most patients (90.79%) who underwent surgical intervention had partial or complete resolution of their symptoms. Seven of 76 knees (9.21%) needed management postoperatively for pain due to trauma, residual symptomatic ossicles, and hardware complications. Of these, four patients required reoperations (average 2 years). The remaining three patients had satisfactory outcomes with an additional course of conservative management and oral analgesics.
Management of symptomatic bipartite patella should begin with a trial of conservative management. With refractory symptoms lasting greater than 3 months, surgical intervention may be considered with positive outcomes of partial or complete resolution of symptoms. The proposed algorithm is provided to guide physician management of symptomatic BPP in pediatric or adolescent patients.
本研究旨在基于对已发表文献的系统评价，为儿童和青少年人群中症状性二分髌骨的管理制定一种循证算法。
根据系统评价和Meta分析的首选报告项目指南，在PubMed和Embase上对文献进行系统评价，选择讨论症状性二分髌骨管理的研究。
五项研究符合标准，涉及315个膝关节（314例患者，平均年龄15.8岁）。所有患者均表现为症状性二分髌骨，并接受了保守治疗的初始试验。76%（239个膝关节）在保守治疗后中位1.9个月症状完全缓解。其余76个膝关节（24.12%）症状持续，需要手术干预。手术技术包括手术切除、螺钉固定、软骨联合钻孔、外侧松解以及关节镜和开放手术（92.1%）。大多数接受手术干预的患者（90.79%）症状部分或完全缓解。76个膝关节中有7个（9.21%）术后因创伤、残留症状性小骨和硬件并发症需要疼痛管理。其中，4例患者需要再次手术（平均2年）。其余3例患者通过额外的保守治疗和口服镇痛药获得了满意的结果。
症状性二分髌骨的管理应首先进行保守治疗试验。对于持续超过3个月的难治性症状，可考虑手术干预，症状部分或完全缓解的结果良好。提供拟议的算法以指导儿科或青少年患者症状性二分髌骨的医生管理。
