# Conservative versus surgical management of pediatric bipartite patella with patellar dislocation: a single-center retrospective analysis

## TL;DR

This study compares conservative and surgical treatments for pediatric bipartite patella with dislocation, finding that surgery leads to better outcomes.

## Contribution

The study provides evidence that surgical management yields superior functional recovery and lower recurrence rates compared to conservative treatment in pediatric bipartite patella cases.

## Key findings

- Surgical treatment resulted in significantly higher Lysholm, Kujala, and VAS scores compared to conservative treatment.
- Surgical patients achieved normalization of patellofemoral alignment and solid bony union in those with internal fixation.
- Recurrence occurred in 27.8% of conservatively treated patients but none in the surgical group.

## Abstract

To evaluate clinical features and compare outcomes of conservative vs. surgical management in pediatric patients with congenital bipartite patella (BP) and patellar dislocation.

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.

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.

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.