What is Patella Alta?
Patella Alta is a condition that involves the kneecap and is characterized by an alteration in the position where the kneecap is positioned higher in relation to the upper leg bone or the femur. It is a rare condition that is mostly occurs in individuals with thin body built and a tall stature and is also referred to as High-ride kneecap. Patella Alta is a condition that can result to weakness and instability of the knees and including its mobility.
The patella or the kneecap is a flat triangular bone situated in front of the knee-joint. It is regarded as the largest sesamoid bone that grew in the tendon of the Quadriceps femoris. The base of the patella is located facing towards the torso while the tip or the apex is facing towards the feet. A thinner margin connects the anterior and posterior surface of the kneecap laterally while a thick margin covers it medially. The anterior surface of the kneecap serves as the attachment of the tendon with Quadriceps femoris.
The patella allows the flexion necessary for mobility and other forms of movements. The flexion is allowed through the articular cartilage. The quadriceps muscle facilitates knee extension via the patella as its fulcrum. Moving from one point to another such as in walking, jumping, running and others are made possible with the help of the knee and all these can be done without the trouble of falling off easily as the patella provides the stability in strength to make all of these achievements.
Individuals suffering from Patella Alta have a kneecap that is oddly positioned higher over the femur. The deformity in the structure can create various symptoms such as:
Gait instability is affected to a degree by the presence of Patella Alta. The stability of the knee is greatly affected that problem with walking and running is observed. Individuals with Patella Alta usually have an unsteady gait.
Pain in the patella is also present although not all patellar pain necessarily means the occurrence of Patella Alta. Other conditions that involve the knee and its adjacent parts can also have patellar pain as a symptom.
Dislocation of the kneecap is the prominent symptom of Patella Alta. In this condition, the patella can bend higher than the normal bent which can pull the knee out of its groove subsequently a dislocation which can be very painful.
Chondromalacia patella is one of the symptoms of Patella Alta. This condition is characterized by blisters and fissures in the surrounding cartilage of the patella aggravated by the misalignment of the patella.
There has been no clear etiology to the occurrence of Patella Alta. The onset on the other hand has been implicated on various factors considered to contribute to the condition and the following factors are:
Injury is one factor considered in the development of Patella Alta. Strenuous activities such as athletic activity can pull the kneecap out during the sudden change in direction. When the kneecap is pulled out of its socket it can result to the dislocation of the patella potential for high-ride kneecap.
Congenital defect is also implicated in the condition. This is basically a defect acquired during the embryonic development and the individual suffering from Patella Alta have the condition since birth.
Body built is also considered potential for Patella Alta. Individual with tall stature and thin body built are prone to the condition predisposed by health conditions such as Patellofemoral pain syndrome and Quadriceps tendinitis.
Twisting of the knee is potential to sudden change of direction. This can result to a dislocation of the patella.
Patellofemoral pain syndrome is implicated in the etiology of Patella Alta. The syndrome is defined as pain arising from contact of kneecap with the thigh bone.
The clinical feature of Patella Alta is observed with a nobly knee. This becomes apparent when the patient is asked to lie down revealing a 90 degree bent of the knee and the patella is apparent on one side and on top of the knee. Pain can be felt at the tip of the patella when a slight pressure is applied.
An imaging test particularly Lateral Radiograph examination can reveal the position of the patella in relation to the knee joint line.
Insall and Salvati method and Blackburne and Peel method are the two medical procedures utilized to determine the variation in patellar position.
Patella Alta can be treated with either a non-conservative treatment or conservative treatment. The goal of treatment is for restoration of strength and stability of the knee including the relief of symptoms.
Sufficient rest will give the patella an ample time to heal while reducing the stress and pressure subjected to the patella by strenuous activities. Ice application can help reduce the pain and inflammation. Physical therapy is necessary to restore the strength and stability of the patella.
Surgical procedures may be done if the patient is unresponsive to non-invasive treatment. Several surgical options are possible depending on the severity of the condition and such surgical procedures may include the following:
- Vastus Medialis Oblique Advancement
- Lateral release