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I just came back from my first physical therapy appointment for a problem with my knee cap. I guess it's in three pieces (two large and one small) because it never fused together like it's supposed to. The therapist gave me a knee brace but I forgot to ask how that's going to help. What can you tell me?

You may have a condition called bipartite patella. Patella refers to the knee cap. It is exactly as you described. The cartilage that makes up the patella doesn't ossify (harden) and form one smooth unit. Instead the person ends up with two or even three separate pieces (fragments). Treatment is only required when the knee develops pain that limits function. Bracing is used along with rest and nonsteroidal antiinflammatory drugs (NSAIDs). The brace supports the patella by immobilizing the knee and limiting flexion (bending). The brace is meant to stop the uneven pull on the patella from the quadriceps muscle (along the front of the thigh). The therapist will probably give you some stretching exercises that should also help. Most people respond well to this type of conservative care. It may take several months to resolve the painful symptoms and restore full function.

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