Knee & Shoulder Surgeon - Orthopedic Specialist
Knee & Shoulder Surgeon - Dr. Amyn Rajani
M.S Orth (Gold Medallist), D-Orth, MBBS
Knee and Shoulder Surgeon
(Arthroscopy & Joint Reconstruction)
Orthopaedic Arthroscopy Knee & Shoulder Clinic (OAKS)

Patella Alta

superior pole patella fracture
Introduction
It is a condition in which the patella is abnormally high riding with respect to the femoral trochlea (groove). This patella is very mobile and is prone to sublaxations and dislocations.

Associated findings :
> small femoral trochlea
> Hypoplasia of vastus medialis

Causes :
Congenital Acquired :
> Patella Tendonitis
> Patella Tendon Rupture

Clinical Features :
> Pain
> Knobly knee sign: At 90 degree flexion patella lying high above the knee and to outer side
> Recurrent sublaxations
> Recurrent dislocations

Investigations :
X-ray: Length of patella ligament = Diagonal length of patella
x ray patellar ligament normal
Normal
high riding patella
High Riding Patella

Conservative Management :
Rest, ice, anti-inflammatory medications
Quadricep muscle strengthening

Surgical Management may involve any one or all of the following :
  • A “lateral release” of the lateral structures is performed to decrease lateral pull on the patella. (controversial)
  • Tibial tubercle (TT) is transferred medially, distally and anteriorly.
  • A “VMO(vastus medialis obliqus) advancement” is performed to move this muscle distally and laterally across the patella to improve its mechanical efficiency.
  • Patella chondroplasty (if necessary) to repair any lesions that may be present on the back of the patella.


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