Patella alta is defined as excessively high-riding patella in relation to the femur, trochlear groove, or tibia, with diminished bone stability. It contributes to patellofemoral instability. It can also be defined using a variety of measurements. Despite the clinical significance of patella alta, there is no consensus on cutoff levels, treatment indications, or optimal correction. It also affects other lateral patellar instability risk factors. Assessing clinical symptoms and selecting a tailored treatment must be addressed. Combined surgical operations may be indicated.

Clinical Anatomy

Flat, inverted triangular patellas are located on the front of the knee. The patellofemoral joint connects the patella to the femoral condyles. A common tendon attaches the tendons to the patella, completely dependent on their function for the patellofemoral articulation. The rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis share the patella's insertion. A strong tendon helps the quadriceps muscle group straighten the leg. Articular cartilage, a firm, smooth material that reduces friction, covers these three bones. The patella is located in the femur's intercondylar groove.

Attenuated Patella Alta

Rarely, attenuated patella alta compromises movement and leg strength. An extremely tiny knee cap (patella) emerges from and above the joint, distinguishing it. Typically, while the kneecap rests in the joint, abrasion from the opposing bones stimulates it to develop. Proper positioning of the kneecap in the joint prevents it from receiving stimulation, resulting in its tiny and immature state.

Causes

Patella alta is categorized as an idiopathic disorder, implying that the cause of the elevated patella is typically not well understood. The most common causes of patella alta are:

• Mild patella alta is a congenital defect that usually occurs during embryonic development and is present at birth.

• Long Patellar Tendon: People with abnormally lengthy patellar tendons (>52mm) frequently suffer from patella alta. 

• Knee Injuries: Patella alta, often a kneecap dislocation, can develop following a knee injury.

Signs & Symptoms

Typical patella alta symptoms:

• Patella alta patients often complain of knee instability when walking or jogging.

• Knee dislocation is common in high-riding patellas. Pushing their kneecap randomly in and out of the patellar groove may cause it to dislocate and shift.

• Patella alta frequently causes anterior knee pain, also known as patellofemoral pain, especially when walking up and down hills, squatting, sitting for long periods of time, and on stairs.

• Knee Buckling

• Weak Knees

Why is the Patella Alta Problematic?

Knee bending and straightening typically move the patella up and down the patellofemoral groove. The groove is deep and blocks sideways kneecap movement, stabilizing the patella. However, the kneecap grows higher than typical at the shallower groove, reducing sideways stability. The patella may dislocate as the knee bends due to sideways dragging across the low edge of the groove. Patella dislocations or subluxations can injure the cartilage on the back of the kneecap, leading to patellofemoral pain and chondromalacia. Patella alta increases knee arthritis, as well as infrapatellar, suprapatellar, and fat pad inflammation.
Contradictory Diagnosis

Patella alta is known to be associated with numerous conditions, including:

• Patellofemoral instability.

• A recurrent patellofemoral dislocation.

• Neuromuscular disorders (poliomyelitis)

• Spastic Cerebral Palsy

• Osgood-Schlatter disease

• Sinding Larsen-Johansson Disease: The condition is known as friction syndrome of the patella tendon and lateral femoral condyle.

Treatment for Patella Alta

Patella alta treatment reduces knee discomfort and instability and restores knee function. For those with Patella Alta, Richardson Pain Management has been helping individuals find relief through their comprehensive treatment plans. Non-operative high-riding patella therapy includes:

Rest

It is crucial to rest from aggravating activities and allow any inflammation to settle.

Exercises

Exercises that strengthen the knee, kneecap, and buttock muscles can correct patella position, alleviate pain, and improve knee stability with a high-riding patella. To find the best workouts for you, try knee-strengthening exercises.

Physical Therapy

Only a certified physical therapist can perform manual therapy to enhance the kneecap-resting position.

Patellar Taping

Taping can also help rectify the patella's position. Your physiotherapist will teach you how to tape your knee yourself, so you can use sports tape when exercising.

Ice Packs

Regularly using ice packs helps relieve discomfort and inflammation in symptomatic patella alta.

Knee Brace

Wearing a knee brace can alleviate the symptoms of a high-riding patella. Ideally, the brace should have a tubular piece that lies above the kneecap to prevent it from riding up.

Medications

To relieve patella alta pain and inflammation, pain management in Dallas may prescribe painkillers such as paracetamol or acetaminophen, or anti-inflammatory medications like ibuprofen/Advil.

Operative Treatment

In extreme cases of patella alta, where the kneecap continues to dislocate, or when conservative treatment fails, orthopedic surgery is required. For patella alta, there are several surgical options:

• Tibial tuberosity: When the patellar tendon connection shifts downward, the patella follows suit. A tibial tuberosity osteotomy removes the tibial tuberosity from the front of the shin bone, shifts it lower, and then reattaches it with screws and wires.

• Lateral Releasing: If tightness on the outer side of the knee shifts the kneecap with a high-riding patella, lateral release surgery can relieve it. 

• Patellectomy: When other surgeries fail or patellofemoral arthritis is severe, the patella is removed.

Recovering After Surgery

For the first two weeks, use crutches because you will only carry light weight through the operated leg. Over the next few weeks, you will be able to progressively raise your leg weight. Most people are off crutches after around six weeks. Check out our best advice for using crutches on stairs. When sitting or lying down, keep your knees raised to help minimize swelling. 

Pillows or a leg elevation cushion should help raise your knee above your heart. After being cleared to move your knee, physical therapy will begin with gentle knee strengthening exercises to restore strength, stability, movement, and function. You can start jogging and gradually progress to mild jogging after three months. Patella alta surgery recovery time usually takes six months to heal and restart high-impact sports. 

Final Words