Abstract
Thank you for taking time to read our recent systematic review on the management of symptomatic bipartite patella in pediatric and adolescent populations. This review only included patients under 21 years and the articles were selected based on patient population and the ability to separate out pediatric and adolescent data from other ages. Individual points will be addressed as they appear in the Letter to the Editor.
In response to the mentioned case report, our review similarly found that many of the pediatric and adolescent patients demonstrated significant symptomatic relief following fragment excision. However, we would caution against complete resection of large fragments. 1
Regarding the use of local anesthetic injections around the bipartite fragment to predict surgical outcomes, we agree that its efficacy in the pediatric population is not well described in the literature. However, the utility of local anesthesia injections as a diagnostic, therapeutic, and prognostic indicator is well described. 2 We would advocate the use of local anesthesia at the site of the bipartite patella as an excellent diagnostic tool, and further as a predictive tool for postoperative response if surgical excision or fixation is selected.
Alternative treatment modalities exist, which our review discusses. The use of such nonsurgical treatments is poorly studied and understood, and we felt that these treatment options require more validity before recommending them as part of a treatment algorithm. We do not necessarily discredit their validity or utility but urge for better studies to help guide clinical decision-making.
This review specifically focused on the pediatric and adolescent population regarding management of symptomatic bipartite patella, and our findings may be applicable to the young adult population based on clinical judgment. However, further studies should be recommended to address a treatment algorithm for an adult population.
Supplemental Material
sj-pdf-1-cho-10.1177_18632521251330829 – Supplemental material for Response to Letter to the Editor: Approaches to the treatment management of symptomatic bipartite patella
Supplemental material, sj-pdf-1-cho-10.1177_18632521251330829 for Response to Letter to the Editor: Approaches to the treatment management of symptomatic bipartite patella by Kristen E Hines, David S Liu, Amy E Steele, Daniel Gabriel, Anjali Prabhat, Yi-Meng Yen and Grant Douglas Hogue in Journal of Children’s Orthopaedics
Footnotes
Author contributions
Kristen E Hines: formal analysis, investigation, methodology, writing—original and draft, review and editing. David S Liu: conceptualization, methodology, formal analysis, Writing—review and editing. Amy E Steele: methodology, formal analysis, writing—review and editing. Daniel Gabriel: formal analysis, investigation, methodology, review and editing. Anjali Prabhat: formal analysis, investigation, methodology, review and editing. Yi-Meng Yen: conceptualization, writing—review and editing. Grant Douglas Hogue: conceptualization, writing—review and editing.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ethics approval
There are no human participants in this article and informed consent is not required.
References
Supplementary Material
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