Frontal Tendon Lengthening Plasty for Treatment of Structural Patella Baja

Abstract

Patella baja is a severe complication seen after trauma, prolonged immobilization and surgery. Several surgical methods have been described to proximalize the patella without a change in the patella tendon length. Yet, patella tendon shortening and thickening can be regarded as the hallmark pathology. As such, we describe a technique for the lengthening of the patellar tendon to pathoconformly address underlying patella baja. The technique is reproducible and gives the possibility of an early postoperative mobilization to prevent re-bajada typical complication after patella baja surgery.

Patellar Tendon Lengthening: Rescue Procedure for Patella Baja

“…Patella baja is a challenging pathologic condition that causes pain and functional restrictions and can even lead to premature osteoarthritis. 4,14,16 So far, a gold In accordance with our preoperative planning, the medial rein of the patellar tendon is moved proximally and the lateral one is moved distally, both the same distance to lengthen the tendon symmetrically. When augmentation with allograft is performed, the bone block of the allograft is inserted in a press-fit manner in the bone defect remaining after harvesting of the bone block of the medial rein.…”

“…13,15 The resultant shortening of the tendon might be due to either shrinkage of the tendon's fibers or a mechanical adherence between the inner surface of the tendon and the anterosuperior aspect of the tibia. [10][11][12][13][14][15] As a result of this pathologic condition, patients may complain of chronic anterior knee pain, 4,16 weakness of the extensor apparatus, 2,3 and restricted range of motion. 4,14,16 If this mechanically unfavorable condition is not properly addressed, a greater risk of development of premature osteoarthritis has also been observed.…”

“…[10][11][12][13][14][15] As a result of this pathologic condition, patients may complain of chronic anterior knee pain, 4,16 weakness of the extensor apparatus, 2,3 and restricted range of motion. 4,14,16 If this mechanically unfavorable condition is not properly addressed, a greater risk of development of premature osteoarthritis has also been observed. 4,14 Conservative treatments of this pathologic condition include physiotherapy, systemic steroids, extracorporeal shock wave therapy, and dry needling.…”

“…Several surgical options have been described for symptomatic patella baja. They include excision of the lower third of the patella, 10 lengthening of the patellar tendon, [16][17][18][19][20] reconstruction of the patellar tendon with allograft, 11,18 and proximalization of the tibial tubercle. 2,20 A combination of 2 or more of these treatments may be recommended in cases of significant patella baja (e.g.…”

Patellar Tendon Tenotomy for Treatment of Patella Baja and Extension Deficiency

“… 5 , 6 , 7 In these cases, surgical intervention is recommended because failure to treat patella baja has been reported to result in limited range of motion (ROM) in extension, persistent anterior knee pain, and accelerated progression of patellofemoral osteoarthritis. 4 , 5 , 6 , 8 , 9 …”