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.

Anatomo-radyographic study in individuals with and without medial patellofemoral ligament rupture

“…Patella alta is also a known risk factor for recurrent instability following isolated MPFL reconstruction [12]. There are studies in the literature examining patella instability reconstruction in individuals with patella alta [11][12][13][14]. Our study results support the literature that patella alta is an anatomical risk factor.…”

“…Dejour et al noted that patella alta was one of the four major reasons for recurrent patellar instability. Patella alta is also a known risk factor for recurrent instability following isolated MPFL reconstruction [12]. There are studies in the literature examining patella instability reconstruction in individuals with patella alta [11][12][13][14].…”

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

“…Servien and Archbold 13 have since suggested a similar technique for patella alta associated with an especially long patellar tendon. While several techniques have been proposed that involve elevation of the anterior half of the patellar tendon while leaving the posterior half intact, 12 , 13 , 14 , 15 , 16 these methods must be approached with great caution, as complete tendon transection poses a risk during the procedure as well as postoperatively in the case of trauma or poor healing. Although tendon repair is possible in the event of complete transection, it may lead to a more difficult recovery and diminished outcomes.…”

“…Patellar tendon imbrication has been proposed as a soft-tissue alternative in skeletally immature patients with patellar instability. 12 , 13 , 14 , 15 , 16 We propose a patellar tendon imbrication technique for the correction of patella alta, which circumvents the need for tendon transection. When used with concomitant MPFL reconstruction, 17 we suggest this procedure may prove beneficial for the treatment of patellar instability in skeletally immature patients.…”

Imbricação do ligamento patelar associado ao reforço com semitendíneo e grácil para patela alta: relato de caso

“…O encurtamento do ligamento patelar com imbricação pode ser uma opção para pacientes com patela alta [7]. Outra opção é associar a ODTAT com o encurtamento do ligamento patelar com imbricação.…”