Surgical Technique for Arthroscopic Resection of Painful Bipartite Patella  Thais D. Vieira, M.D., Mathieu Thaunat, M.D., Adnan Saithna, M.B.Ch.B., Dip.S.E.M., M.Sc., F.R.C.S.(T&O), Olivier Carnesecchi, M.D., Eric Choudja, M.D., Maxime Cavalier, M.D., Jose Roberto Benites Vendrame, M.D., Andrew Charles Ockuly, D.O., Bertrand Sonnery- Cottet, M.D.  Arthroscopy Techniques  Volume 6, Issue 3, Pages e751-e755 (June 2017) DOI: 10.1016/j.eats.2017.02.007 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Illustration of a right patella viewed anteriorly, showing the Saupe classification of bipartite patella: type I, inferior pole (*); type II, lateral margin ($); type III, superolateral pole (#). Arthroscopy Techniques 2017 6, e751-e755DOI: (10.1016/j.eats.2017.02.007) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Single photon emission computerized tomography/computerized tomography images showing increased uptake (white arrow) in the superolateral pole of the patella of the left knee correlating with the symptomatic synchondrosis of a Saupe type III bipartite patella. (A, A′) Axial, (B, B′) sagittal, and (C, C′) coronal sequences. Arthroscopy Techniques 2017 6, e751-e755DOI: (10.1016/j.eats.2017.02.007) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 Patient setup for arthroscopic excision of bipartite patella in a left knee; a lateral post (*) is positioned just proximal to the knee, at the level of the padded tourniquet (white arrow). (A) A foot roll ($) is used to keep the knee flexion at 90° (B). Arthroscopy Techniques 2017 6, e751-e755DOI: (10.1016/j.eats.2017.02.007) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 Synchondrosis identification. (A) A needle (white arrow) placed percutaneously in the anterior face of the left patella is used to clearly identify the margins of the synchondrosis (black arrows). (B) At arthroscopy of the same knee, using a 30° arthroscope, the percutaneously placed needle (white arrow) provides a clear landmark to guide fragment excision. Arthroscopy Techniques 2017 6, e751-e755DOI: (10.1016/j.eats.2017.02.007) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 Left knee. Arthroscopic images taken with a 30° arthroscope using standard anteromedial and anterolateral portals. Debridement of the synchondrosis is commenced using a shaver (*) at the margin of the synchondrosis (A) to separate the fragments (dotted line) (B). (C) Radiofrequency ablation ($) can be used to “shell out” the bipartite fragment. (D) Removal of fragments (⌘) is then performed with an arthroscopic grasper. Arthroscopy Techniques 2017 6, e751-e755DOI: (10.1016/j.eats.2017.02.007) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions