The patello-femoral joint :

Patella Alta - - Posted by msunflower (msunflower), 10 January 2005

I am in a lot of pain and have been told that i have patella alta.  Has anyone else been told this?  If so have you found anything that can fix this problem and releive pain?  Thanks!

Michelle
Posted by imnotpunk (imnotpunk), 11 January 2005

Michelle -

Patella alta is when your patella is basically too high on the femur in terms of positioning. I have experienced this myself due to a ruptured patellar tendon. My patella was re-positioned during patellar tendon reconstruction, my OS basically used my other knee to determine where my patella should be positioned, then placed it in the right spot corresponding to the other patella while the knee was bent at a 45 degree angle. The patella was kept in place by drilling small holes in the top and bottom and using heavy duty sutures connected to certain anchor-spots.

Patella alta is comminly seen in patellar tendon ruptures and also severe tendonitis. Do you have any tendon pain? You might want to ask your doctor if it is possible that you could be suffering from tendonitis.

When you have patella alta, you are prone to knee dislocations, which can be very painful and frustrating.

In terms of treatment, if your patella alta is causing you constant knee dislocations or knee pain, then there are both non-operative (conservative) and operative (aggressive) approachs towards alleviating the problem. A combination of strengthening and RICE is probably your best bet. Your doctor may want to put you into a physical therapy program to strengthen the quadriceps muscle. With more strength, your knee will become more stable and this may help the problem. However, sometimes a conservative approach doesn't always work and you may need to have the problem corrected surgically. There are surgical options as well, including arthroscopy to shave the patella, a patellectomy, having a lateral release done (which has become a very controversial procedure as of late), a VMO advance, or even a TTT(or TTO).

Hope any of this helps and I hope you feel better.

Best wishes,
Patricia
Posted by anasta5ia (anasta5ia), 11 January 2005

Michelle-

I have had pretty severe patella alta my entire life.  This, combined with hypermobility issues and a very shallow femoral groove all led me down the path of constant patella dislocations.

My OS has actually had to do a modified TTT where they actually advance the tibial tuberosity by detaching it and pulling it about an inch and a half down towards my foot and screwing it in there.

I am going to have another advancement done on my left knee soon....it is amazing how differently the before and after pics look with respect to the position of my kneecap.

If you have any questions, don't hesitate to IM me....

Hugs-
Heather G.
Posted by BridgetJones_uk (BridgetJones_uk), 12 January 2005

Mines basically been pulled down by semitendinosus! A bit like a lassoue! Has done the trick though, I now have one normalish looking knee (the operated on) and one still very pointy one where the patella rides up high!

M
xxxx
Posted by Yanks351 (Yanks351), 17 January 2005

Hey I am 22  and I suffer from severe patella alta. My kneecap subluxes 3-4 times a day and often i don't even have to have weight on it   Anyway I have had 2 surgeries already and I am getting ready to have a 3rd. The doctor thought about doing a LR but with how severe my dislocations are I am wondering if that will be enough. I mean I don't want to have a 4th surgery if I don't need it. What do you guys think?
Yanks
Posted by shadehawk (shadehawk), 18 January 2005

Hi Yanks, I might be wrong here but I thought that an LR was to correct only patella tilt.  I did not think it would move your patella down into a more correct position, but I could be wrong.  Another OS opinion would not hurt though and then you might feel more comfortable in making your decision.

Maybe you should go to a knee specialist from the list on this site and get a second opinion.  Like you said you have already had 3 surgeries and want to make sure that you get the correct proceedure for your condition.  

Good luck to you!  
Posted by DrThea (DrThea), 18 January 2005

I concur with Shadehawk - get a second opinion!  LRs are not usually done alone and will not help mal-alignment or in your case - patella alta!  LR are not fun to recover from - don't do it unless you are really sure it will help.

All the best to you!

Thea


Posted by Yanks351 (Yanks351), 18 January 2005

Hey guys
  Thanks for your help. I am going to a doctor recommended from the list on this site. I also had a family friend who is a doctor make a few calls to make sure that this doctor would be a good match for me. I have an appointment with him on the 26th so hopefully I can get my knee fixed ASAP. Thanks
   Yanks
Posted by shadehawk (shadehawk), 18 January 2005

Good news, Yanks!

Let us know how everything goes at your appointment.
Posted by MedicJess (MedicJess), 20 January 2005

I just found out a couple of appt's ago that I also have patella alta. We were looking at my post TTT xrays and I commented on how high the patella appeared to be riding. The OS said "Yeah, you've got some good patella alta, but I didn't do anything about that in the surgery."  Now I'm hoping that this TTT is successful (duh) and that I have no further problems.  BUT.. should I encounter any..what other surgical options are there?  Someone mentioned shaving the patella, but I'm not sure what the advantage to that would be?
And good luck msunflower!
Jessie
Posted by RGrelsamer (RGrelsamer, MD), 21 January 2005

Patella alta is indeed a condition whereby the kneecap rides high. It is most commonly congenital. it can be mild or severe. Patella alta is not AUTOMATICALLY a source of problems, so the first thing to do is to confirm that it IS the source of YOUR pain.
After that, yes the patella can be lowered.
Posted by Yanks351 (Yanks351), 24 January 2005

Hi,
  I have patella alta, and I didn't find out until just a few months ago. My knee has some major mal-tracking issues and what I just found out is that the groove where my kneecap sits, one of the sides it too low and the doctors can't really do anything about that because thats just how I was made. But my mal-tracking causes my knee to sublux and dislocate several times a day. My 2 surgeries were done by 2 different doctors, and I just found out I had patella alta from my 3rd OS. She recommended a LR and possible TTT, she also said I have significant chondromalacia.  On Wed. I am going to see a specialist and hopefully find out for sure what surgery I will be having. What do you thing is next for me? My first surgery was a MPFL, and my second surgery reattached that and also put 3 screws into my kneecap.  Just trying to figure out what the next step is...
Posted by shadehawk (shadehawk), 24 January 2005

Hey Yanks, glad to hear that you are going to go to an OS who specializes in knees.  You must make sure though that you do not sign on for an LR alone as it does not fix mal-tracking only patella tilt.  

Good luck on your appointment.  Let us know how it all goes.

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