- Discussion:
    - multipartite patella may present diagnostic dilemma in child with anterior knee symptoms;
    - these often incidental radiographic findings have been classified into three types:
         - type I--at inferior pole (5 % of all lesions)
         - type II--at lateral patellar margin (20 %)
         - type III--at superolateral pole (75 %)
    - exact prevalence of bipartite or multipartite patella is unknown;
         - bilaterality is uncommon;
         - strong nine-to-one male dominance has been a consistent finding;

- Diff Dx:
    - acute fracture
    - stress fracture
    - dorsal patellar defect;

- Exam:
    - exam of symptomatic knee shows slightly enlarged patella w/ tenderness at junction of the main body of patella and the fragment;

- Treatment:
    - depends on acuity and severity of symptoms;
    - w/ acute injry, pain is usually due to separation between fragment and the main body of patella, & knee immobilization for 3 weeks wil suffice;
    - in chronic cases, modification of activity over three to four weeks may be all that is required for resolution;
    - if symptoms persist, entire fragment, through region where fragment meets the body of the patella, may be excised to eliminate the 
         painful pseudarticulation;

Painful Bipartite Patella. A New Approach to Operative Treatment.

Painful bipartite patella following injury.