Patella Alta

Definition: What is Patella alta?

It is a medical condition of your patella, which is another word for kneecap. When a person has patella alta your kneecap rests in an abnormally high position. This position is in relation to your upper thighbone, referred to as your femur. Your patella will typically be displaced at one to one and one-half times its length or more out of place. Although this is a rare medical condition, there are some who suffer from it but it does not always create medical problems. People who take up activities like running are more likely to suffer from patella alta. If you are a runner you can lower your chances of developing patella alta by switching to lower-impact exercise such as biking.

Anatomy

Your knee is the largest joint in your body and is formed by the articulations of your thighbone (femur), one of your lower leg bones (tibia), and your kneecap (patella). Articulation means the manner in which the bones come together at the joint, which is your knee. Your kneecap, or patella, is a small bone that is triangular in shape and is embedded within the tendon of the quadriceps femoris, which is the large muscle of the front of your thigh. The patella is very important for the stability of your knee joint.

Symptoms

When you have patella alta it usually results in pain in the front section of your knee. Other symptoms it might cause can include:

• Kneecap instability
• Gait that is unsteady when walking and running
• Having an adverse effect on the mobility of your knee

It can also cause additional problems like traumatic failure of a supporting ligament or patellar dislocation, which is an injury of your knee and your kneecap slips out of place. If there is a misalignment of your patella, it could aggravate the surrounding cartilage and cause it to wear down, fissuring, or blistering. These conditions are referred to as chondromalacia patella, which means runner’s knee.

Causes

• Patella alta can happen genetically with an abnormally shaped trochlear sulcus, which is the concave region at the lower end of your femur. It is also referred to as your femoral groove.
• It can also occur due to muscle imbalances when the tight muscles draw your kneecap upward into the femoral groove.
• You can also develop patella alta because of an injury or knee surgery.
• Be associated with Osgood-Schlatter’s disease, which is a disease that can cause a painful lump below the kneecap in children and adolescents during puberty when they are experiencing growth spurts.

Diagnosis

This medical condition may be diagnosed by using a lateral radiograph of your knee, which is a side-view x-ray. The physician may also have an MRI (magnetic resonance image) done but this type of image may not accurately reflect the portrayal of cartilage damage. In order to evaluate the situation of the groove and bone, the positioning, and cartilage wear they may use an arthroscope. It is inserted and transmits high-quality illuminated digital video pictures.

Treatment

When treating patella alta the physician can use non-invasive treatments like knee sleeves, tape, or braces. They may even use physiotherapy. Your physician may also prescribe arch supports to help train the positioning and movement of your patella and even medication. There are some common exercises that you can do such as leg exercises and stretching your hip flexor muscle and quadriceps. Physical therapy and the proper exercises are a crucial part of the treatment. To help relieve the pain that could occur behind your kneecap around the cartilage area you can use ice packs. If you are overweight, your physician may suggest that you lose weight.Because the symptoms can worsen overtime due to repeated stress on your knee joint you should take time to rest your knee as much as you can, including not doing any strenuous physical activities that involve your knee joint. You can also use compression on your knee, which is wrapping it with a compression bandage, to help with any swelling. Keep your leg elevated when you are sitting or lying down.

Surgery

Although in most cases surgery is not necessary for treating patella alta unless it is a severe case and non-evasive treatment is not working. There are several arthroscopic or open surgical procedures that can be done, which include:

• Patellectomy - this is the total or partial removal surgically of your kneecap under general anesthesia but in some cases, the surgeon will use an epidural or spinal anesthetic. An incision will be made over the front of your kneecap and examined. If all or part is so severely damaged it cannot be repaired it will either be totally or partially removed. If it is totally removed, the tendons and muscles attached to your kneecap are cut before the kneecap is removed. In order for you to extend your knee after total removal of your kneecap the soft tissues around your kneecap, the patellar tendon below the kneecap, and the quadriceps tendon above the kneecap are preserved. The final step is sewing the muscles together and closing the incision with clips or sutures that stay in for two weeks.
• Arthroscopic lateral release - with this surgery the tight ligaments on the outer, or lateral, side of your kneecap are cut to allow it to slide more towards the center of the groove of your thighbone. The ligaments will heal overtime and the gap that this surgical procedure created will be filled with scar tissue. If you have patellar instability this is not a procedure to consider as it is not a very effective treatment for this medical condition.
• Tibial tuberosity advancement osteotomy - with this surgical procedure an incision is made at the front of your knee over the tibial tuberosity, which is the bony protrusion at the top of your tibia bone in your lower leg. It, along with your patellar tendon, are cut from your tibia and shifted downwards followed by the placement of the bone of your tibial tuberosity into place in the new position. This is done with the help of a steel wire band and a screw.

Rehab after surgery

With most surgeries you will be kept in the hospital overnight. When you leave the hospital in the morning you will be given a knee brace to wear along with crutches. There is a hinge on the brace that will prevent you from bending your knee too much while it heals. To begin with the brace is locked at zero to twenty degrees flexion but as your knee starts to rehab the range of flexion is increased. By six weeks after surgery most are ready to get rid of the crutches and knee brace. After six weeks is when you will start intensive physiotherapy treatments two to three times a week. This is to help you gain strength, movement, and flexibility in your knee. By three months after surgery most people’s knees will be healed enough for them to start impact-type exercises like lunges and building up to slow jogging. To totally recover from surgery it can take you up to six months.