Patella baja in total knee arthroplasty can result in impingement, pain, and decreased range of motion. Etiology can range from previous knee surgeries such as anterior cruciate ligament reconstruction, retrograde femoral nail, infrapatellar fat pad resection, and previous total knee arthroplasty. Diagnosis can be confirmed by one of a number of measurements of patellar height including Insall-Salvati and Blackburne-Peel ratios. It is important to differentiate between true patella baja and pseudopatella baja by patellar height ratio. Treatment includes correct identification of the underlying etiology and appropriate management. Surgical management strategies include tibial tubercle osteotomy, distal femoral augment and revision, proximalization of the patellar component, modification of the anterior tibial component, and/or Z-plasty of the patellar tendon. We review the outcomes for each of these procedures.
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[Modified Z-plasty of the patellar tendon for patella baja and flexion deficits].
Oper Orthop Traumatol
January 2025
Klinik für Orthopädie und Unfallchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar-Theyss-Str. 27-33, 14193, Berlin, Deutschland.
Objective: Lengthening of the patellar tendon to normalize patellar height and improve knee flexion deficits.
Indications: Flexion deficits in combination with patella baja (Caton index < 0.6).
Purpose: Tibial rotational deformity is a known risk factor for patellofemoral joint (PFJ) disorders. However, it is commonly associated with other abnormalities which affect the PFJ. The purpose of this study was to describe the prevalence of associated factors known to affect PFJ in patients undergoing rotational tibial osteotomy and their implication for the correction level.
View Article and Find Full Text PDFPatella height ratios diagnose the same healthy knees differently.
Sci Rep
January 2025
University of Turin, CTO Hospital (C.T.O. Centro Traumatologico Ortopedico), Via Gianfranco Zuretti, 29, Torino, 10126, TO, Italy.
Article Synopsis
- The study evaluates whether the Insall-Salvati and Caton-Deschamps ratios align with normal distribution patterns in healthy knees, using data from 434 CT-scanned knees.
- Results showed that while the Insall-Salvati ratio identified the 98th centile correctly for patella alta, it overdiagnosed patella baja, while the Caton-Deschamps index also revealed discrepancies in diagnosing patella baja at the 5th centile.
- Overall, the study found poor inter-rater reliability between the two ratios, as indicated by a kappa coefficient of 0.01.
Adhesions in the deep infrapatellar region may occur as iatrogenic complications (e.g., after bone-patellar tendon-bone grafting), as part of arthrofibrosis or infrapatellar contracture syndrome, or owing to specific diseases such as Osgood-Schlatter disease.
View Article and Find Full Text PDFA novel assessment of the differences in various measurements in patients with patella alta and baja: a retrospective cross-sectional study.
Quant Imaging Med Surg
December 2024
Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey.
Background: Insall-Salvati index (ISI) is widely used to evaluate patella position, the specific relationship between quadriceps patellar tendon angle (QPA) and patellofemoral measurements remains unclear. Understanding this relationship could provide valuable insights into diagnosing and treating knee pain, instability, and patellofemoral pathologies more effectively. In this study, we aimed to assess whether there was a significant difference between the patients with patella alta and baja in terms of many patellofemoral measurements and pathologies.
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