Efficacy and Limitations of Conservative Treatment for Painful Patella Partita: Positioning of an Ultrasound-Accelerated Fracture Healing Apparatus.

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Abstract

OBJECTIVE

Generally, painful patella partita is conservatively treated, but the usefulness of a low-intensity pulsed ultrasound (LIPUS) healing apparatus is unclear. The objective of this study was to investigate the usefulness of LIPUS for conservative treatment of painful patella partita.

SUBJECTS AND METHODS

The subjects included 17 patients diagnosed with painful patella partita. The subjects were divided into 2 groups: those without pain at 6 months (responsive group) and those with pain that persisted for 6 months or longer (non-responsive group). The reasons for the different responses between the 2 groups were investigated. We evaluated various factors, including age, gender, presence or absence of epiphyseal closure on plain xp at the first examination, Saupe classification, presence or absence of bone union, and type of conservative treatment. The grade of limitation of movement, the presence or absence of instruction on quadriceps femoris muscle stretch, and use of an orthosis and LIPUS were also investigated.

RESULTS

The responsive and non-responsive groups consisted of 12 and 5 patients, respectively, and included only male patients. The average age was 13 and 16 years old in the responsive and non-responsive groups, respectively. Epiphyseal closure was present in 1 of the 12 patients in the responsive group and 3 of the 5 patients in the non-responsive group. The Saupe classifications in the responsive and in the non-responsive groups, respectively, were type I in 1 and 2 patients (3 total), type II in 6 and 1 patients (7 total), and type III in 4 and 3 patients (7 total). Bone union was achieved in 10 patients in the responsive group, whereas no patient achieved bone union and 3 patients underwent excision in the non-responsive group. Conservative treatment in the responsive and non-responsive groups, respectively, included prohibition of exercise for 7 and 2 patients (9 total) and instruction on quadriceps femoris muscle stretch for 5 and 2 patients (7 total). In addition, all of the 8 patients wearing an orthosis and 2 patients treated with LIPUS were in the responsive group.

DISCUSSION

The findings suggest that painful Saupe type II patella partita can be improved by appropriate conservative treatment before epiphyseal closure. LIPUS may be advantageous for bone union and pain relief.

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