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Patellar Tendon Imbrication for Patella Alta.

ABSTRACT: Patella alta is a significant contributor to patellar instability. Historically, distalizing tibial tubercle osteotomy has been recommended for this problem; however, complications such as nonunion, fracture and hardware irritation are concerning. Additionally, the procedure cannot be performed on skeletally immature patients without violation of the proximal tibial physis. The authors describe a technique of patellar tendon imbrication that does not involve hardware or osteotomy. This technique allows for reliable correction of patella alta and provides patellar stability without the complications associated with osteotomy.

SUBMITTER: Kakazu R

PROVIDER: S-EPMC8807527 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Patellar Tendon Imbrication for Patella Alta.

Kakazu Rafael R Luczak S Brandon SB Grimm Nathan L NL Fitzsimmons Kevin P KP Andrish Jack T JT Farrow Lutul D LD Pace J Lee JL

Arthroscopy techniques 20211220 1

Patella alta is a significant contributor to patellar instability. Historically, distalizing tibial tubercle osteotomy has been recommended for this problem; however, complications such as nonunion, fracture and hardware irritation are concerning. Additionally, the procedure cannot be performed on skeletally immature patients without violation of the proximal tibial physis. The authors describe a technique of patellar tendon imbrication that does not involve hardware or osteotomy. This technique ...[more]

PMID: 35127423

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Patellar Tendon Imbrication for the Treatment of Patella Alta in Skeletally Immature Patients.

Project description:Patella alta is a major contributor to recurrent patellar instability, which is commonly seen in young athletes. Distalizing tibial tubercle osteotomy has been used for the correction of patella alta and patellar instability, but this procedure is contraindicated in the skeletally immature patient population, as it could lead to growth arrest of the proximal tibial physes. We propose a patellar tendon imbrication technique as a soft-tissue alternative to tibial tubercle osteotomy. When used with concomitant medial patellofemoral ligament reconstruction, we suggest this procedure may prove beneficial for the treatment of patellar instability in skeletally immature patients.

| S-EPMC9519932 | biostudies-literature

Patellar Tendon Shortening for Treatment of Patella Alta in Skeletally Immature Patients With Patellar Instability.

Project description:Aberrant anatomy, such as patella alta, can be a risk factor for recurrent patellar instability or inferior clinical outcomes after medial patellofemoral ligament reconstruction. In patients with significant patella alta (Caton Deschamps Index >1.2), tibial tubercle distalization may be considered to improve outcomes. However, despite patellar instability commonly affecting pediatric patients, a distalization osteotomy is not feasible in this patient population due to the presence of open physes. Our article presents a technique describing an alternative soft-tissue distalization approach whereby patellar height is decreased by shortening the patellar tendon.

| S-EPMC8355506 | biostudies-literature

Patellar Tendon Lengthening: Rescue Procedure for Patella Baja.

Project description:Patella baja is a challenging pathologic condition that causes pain and functional restrictions and can even lead to premature osteoarthritis-even more so in cases of patella infera or cases associated with degeneration of the patellar tendon in which simple conservative treatment frequently is not resolutive. Several surgical options have been described for symptomatic patella baja: excision of the lower third of the patella, lengthening of the patellar tendon, reconstruction of the patellar tendon with allograft, and proximalization of the tibial tubercle. A combination of 2 or more of these treatments may be recommended in cases of significant patella baja. We present a simple and reproducible technique to address patella baja that combines a partial transposition of the tibial tubercle and patellar tendon lengthening using a subperiosteal patellar flap in continuity with the patellar tendon.

| S-EPMC6993128 | biostudies-literature

Tibial Tubercle Osteotomy With Anteriorization and Distalization for Treatment of Patellar Instability With Patella Alta.

Project description:Patellofemoral instability is a common cause of knee pain that can lead to long-standing pain, chondral injury, recurrent dislocations, and degenerative changes if not treated appropriately. Tibial tubercle osteotomy is indicated when there is anatomy predisposing to patellar maltracking and instability, namely abnormal patellar height or tibial tubercle location. In this Technical Note, we describe a technique for tibial tubercle anteriorization and distalization as part of the overall treatment algorithm for patellar instability with associated patella alta. This method of tibial tubercle osteotomy reliably produces anterior and distal translation of the patella to correct patellar height and decrease contact pressure across the patellofemoral joint.

| S-EPMC9244642 | biostudies-literature

Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: an upright, weightbearing MRI study.

Project description:The purpose of this study is to determine if patellar maltracking is more prevalent among patellofemoral (PF) pain subjects with patella alta compared to subjects with normal patella height. We imaged 37 PF pain and 15 pain free subjects in an open-configuration magnetic resonance imaging scanner while they stood in a weightbearing posture. We measured patella height using the Caton-Deschamps, Blackburne-Peel, Insall-Salvati, Modified Insall-Salvati, and Patellotrochlear indices, and classified the subjects into patella alta and normal patella height groups. We measured patella tilt and bisect offset from oblique-axial plane images, and classified the subjects into maltracking and normal tracking groups. Patellar maltracking was more prevalent among PF pain subjects with patella alta compared to PF pain subjects with normal patella height (two-tailed Fisher's exact test, p<0.050). Using the Caton-Deschamps index, 67% (8/12) of PF pain subjects with patella alta were maltrackers, whereas only 16% (4/25) of PF pain subjects with normal patella height were maltrackers. Patellofemoral pain subjects classified as maltrackers displayed a greater patella height compared to the pain free and PF pain subjects classified as normal trackers (two-tailed unpaired t-tests with Bonferroni correction, p<0.017). This study adds to our understanding of PF pain in two ways-(1) we demonstrate that patellar maltracking is more prevalent in PF pain subjects with patella alta compared to subjects with normal patella height; and (2) we show greater patella height in PF pain subjects compared to pain free subjects using four indices commonly used in clinics.

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Clinical Improvement Is Achieved Following Tibial Tubercle Distomedialization for Patellar Maltracking and Patella Alta Without Instability.

Project description:PurposeTo determine short-term patient-reported outcomes following distomedial tibial tubercle transfer (TTT) in patients with patellar maltracking and patella alta without instability.MethodsA single-surgeon case series study was performed on patients receiving distomedial TTT for the indication of patellar maltracking and patella alta without instability, after nonresponse to conservative treatment. Patient-reported outcomes were assessed preoperatively and at 3-, 6-, 12-, and 24-month follow-up using Kujala, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analog scale (VAS) pain scores. Generalized estimating equations analyses were performed to study improvement over time. Minimal clinically important differences obtained from literature were used to determine clinical relevance.ResultsA total of 40 patients were included. Eight patients were lost to follow-up; thus, outcomes of 32 patients were analyzed. Mean follow-up was 22 months, median age was 21 years, and 75% were female. Mean Kujala score increased pre- to postoperatively from 55 ± 12 to 79 ± 16 (P < .001), KOOS from 48 ± 14 to 79 ± 15 (P < .001), and VAS from 64 ± 17 to 25 ± 21 (P < .001), respectively. Eighty-four percent had clinical improvement of Kujala score, 91% of KOOS, and 78% of VAS score. A plateau phase in pain reduction was reached at 3 months, and in functional improvement at 6 months follow-up, after which no further significant improvement was observed. Complication rate was 3% and removal of hardware rate was 72%. Conclusions: In this case series study, distomedial TTT led to clinically relevant functional improvement and pain reduction in patients with patellar maltracking and patella alta without instability. However, the removal of hardware rate was high (72%).Level of evidenceLevel IV, therapeutic case series.

| S-EPMC8220615 | biostudies-literature

Patellar Tendon Tenotomy for Treatment of Patella Baja and Extension Deficiency.

Project description:Extension loss due to patella baja is a rare but devastating postoperative complication associated with knee surgery. The most common causes of patella baja are prolonged postoperative immobilization, over-distalization of the patellar tendon during patella-related surgical procedures (i.e., tibial tubercle osteotomy and patellar tendon reconstruction), and inadequate knee range-of-motion exercises postoperatively. Patella baja can cause significant functional limitations owing to knee-related stiffness, pain, and weakness. Arthroscopy with scar tissue debridement is the standard of care for patients with arthrofibrosis in whom conservative treatment has failed. However, when this surgical approach fails, patients with continued patella baja may be candidates for open patellar tendon tenotomy as a salvage procedure.

| S-EPMC6475627 | biostudies-literature

Technique for Fixation of Semitendinosus to the Patella in Patellar Tendon Reconstruction.

Project description:Chronic patellar tendon injuries are rare yet challenging to treat. Timing of surgery and graft choices are debatable. Many techniques and methods of fixation have been described with pros and cons. Functional impairment of the extensor mechanism and postoperative complications triggers the quest for finding the ideal technique. In this Technical Note, we use distally based semitendinosus (ST) looped over 2 ETHIBOND sutures. The ETHIBOND is passed through 2 vertical tunnels in the patella and retrieved proximally, docking the ST in a blind tunnel created in the lower pole of the patella. The whip-stitched free ST end is passed through a tunnel behind the tibial tubercle and sutured back to its base. A polyester tape is used to augment the repair in a circumferential manner. Postoperatively full weight bearing is allowed as tolerated in a hinged knee brace locked in extension with only passive range of motion of 0-90° allowed for 6 weeks.

| S-EPMC7768288 | biostudies-literature

Semitendinosus Tendon Transfer Associated With Distal Alignment for Patella Alta in a Patient With Recurrent Dislocations.

Project description:Patellofemoral instability is characterized by pain during normal daily activities and frequent dislocation events. In the reported case, an adolescent girl, aged 15 years, affected by left patellofemoral instability, underwent surgery with a double technique comprising tibial tubercle distalization and medial patellofemoral ligament reconstruction. In case of patella alta associated with patellofemoral instability, surgical treatment should focus on medial patellofemoral ligament repair and on recurrent instability prevention.

| S-EPMC4722132 | biostudies-literature

Management of Neglected Patellar Tendon Rupture via the Ilizarov Apparatus and Patellar Transport Following Multistage Reconstruction using Contralateral Patella Tendon Bone Autograft: A Case Study.

Project description:Muscle elongation by Ilizarov apparatus is one of the most remarkable surgeries performed to date. Chronic patella tendon injury is an uncommon condition, and due to its rarity, it is difficult to operate and restore the quality of life and function of the patient. Here we demonstrated a 40-year-old Saudi person who underwent a three-stage operative procedure on him: in the first stage we entailed debridement and removal of the implant; in the second stage, we performed this innovative Ilizarov muscle elongation of the quadriceps, and in the third stage, we reconstructed the right patellar tendon using a contralateral patella tendon bone autograft fixed by 3.5 screws proximal to the patella and distal to the tibial tuberosity and augmented by cerclage wires. After 3 months of intensive physical therapy, the patient regained his knee's range of motion and muscle strength and was able to return to his security job.Graphical abstractSupplementary informationThe online version contains supplementary material available at 10.1007/s43465-022-00608-5.

| S-EPMC9043083 | biostudies-literature

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