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Patellar Tendon Tenodesis for the Treatment of Patella Alta
91
Patients reported they were very satisfied with
their knee in fifteen cases (55.5%), satisfied
with their knee in ten cases (37.0%), and
disappointed with their knee in two cases
(7.4%) at final follow-up. The patellar
apprehension test remained positive in nine
knees (33.3%).
Outcomes Data
The case series above demonstrates that
technique of tibial tubercle distalization and
patellar tendon tenodesis outlined above results
in normalization of patellar tendon length and a
stable patellofemoral joint in patients with patella
alta and EPD. Long-term follow-up revealed
high patient satisfaction and knee function
according to the subjective IKDC score.
Numerous other authors have hypothesized
that addressing patella alta in patients with
EPD through distalization of the tibial tubercle
would stabilize the patella [2, 5]. A recent study
by Caton
et al.
described achieving perfect
patellar stability in 77% of patients treated with
distalization/medialization of the tibial tubercle,
but do not clearly define the criteria used for
this assessment [3]. Simmons
et al.
reported no
recurrent dislocations in a group of 15 patients
treated with tibial tubercle distalization [19].
Pritsch et al reported 6-year results of their
series of 63 knees treated for EPD with tibial
tubercle medialization in all cases and
distalization in 90% of cases [18]. They
reported good or very good Lysholm scores in
73% of patients, recurrent dislocation in one
patient, and recurrent patellar subluxation in 5
patients. The patellar apprehension test
remained positive in 15% of knees. Palmer
et
al.
reported 5.6-year outcomes of 59 knees
with patellar instability treated with tibial
tubercle medialization and distalization [17].
They noted two cases of recurrent dislocation
and 79% had good or excellent results. We are
aware of no other studies in which episodic
patellar instability was addressed through a
tenodesis of the patellar tendon.
Conclusion
Patellar tendon tenodesis results in normali
zation of patellar tendon length and a stable
patellofemoral joint and good long-term knee
function when performed in association with
tibial tubercle distalization in appropriately
selected patients with EPD associated with
patella alta and an elongated patellar tendon.
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