From the Guidelines
Management of patella alta should prioritize conservative measures, including individualized knee-targeted exercise therapy and education, with a focus on hip and knee strengthening, as well as addressing movement patterns and tissue tolerance to load, as supported by the most recent evidence 1. The goal of treatment is to improve patellar tracking, reduce pain and inflammation, and enhance functional ability.
- Key components of conservative management include:
- Knee-targeted exercise therapy, with a focus on quadriceps and hip strengthening, as well as movement pattern modification
- Education on pain management, load modification, and functional activities
- Addressing tissue tolerance to load and movement patterns, such as single leg squats and treadmill running
- Use of prefabricated foot orthoses, taping, and manual therapy as adjuncts to exercise therapy, as needed
- Exercise therapy should be prescribed relative to specific severity and irritability, with a greater focus on hip exercises in people with poor tolerance to loaded knee flexion, as recommended by experts in the field 1.
- Patients should be educated on the importance of gradual progression of exercises, load modification, and pain management, with the goal of promoting autonomy and reducing fear avoidance behaviors.
- If favourable outcomes are not observed after a realistic period (minimum 6 weeks), clinicians should revisit assessment findings to ensure that intervention(s) align well with their initial line of reasoning, and/or review patient engagement, as suggested by recent studies 1.
- Surgical options, such as tibial tubercle osteotomy procedures or medial patellofemoral ligament reconstruction, may be considered in cases that do not respond to conservative treatment or have significant instability or pain, but should be reserved for cases where conservative management has failed.
From the Research
Management of Patella Alta
The management of patella alta, also known as high-riding patella, can be complex and may involve various treatment options.
- Nonoperative management is often the first choice of treatment, which can include physical therapy, anti-inflammatory medication, and orthosis 2.
- In some cases, surgical management may be necessary to improve stability and address underlying anatomical risk factors 2.
- Tibial tubercle distalization with or without patellar tendon tenodesis are two common surgical procedures used to treat patella alta 3.
- A computational study found that distalization led to lower cartilage stress than distalization + tenodesis, and an Insall-Salvati ratio of 0.95 may be an ideal level for distalization 3.
Treatment Options
Some treatment options for patellar tendinopathy, which may be related to patella alta, include:
- Eccentric exercises and physical therapy 4, 5
- Injection therapies, such as platelet-rich plasma and corticosteroids 6, 4
- Extracorporeal shockwave therapy and orthosis 6, 4
- Surgical treatment, such as open or arthroscopic debridement of the patellar tendon, may be effective in refractory cases 4
Biomechanical Considerations
Biomechanical factors, such as patellofemoral joint contact mechanics, can play a crucial role in the management of patella alta.