Attenuated patella alta

Attenuated Patella Alta is a condition characterized by an abnormally high position of the patella (kneecap) in relation to the femur (thigh bone). This condition is a variant of patella alta, which itself refers to a high-riding patella. However, the term "attenuated" suggests a particular aspect of patella alta where there might be additional factors such as elongation or stretching of the patellar tendon, contributing to the abnormal positioning. This condition can affect knee mechanics and stability, leading to potential complications such as patellofemoral pain syndrome, chondromalacia patellae, and increased risk of patellar dislocation.

Causes

Attenuated patella alta can be caused by various factors, including congenital anomalies, where the individual is born with an unusually long patellar tendon, or it can be acquired due to conditions that stretch the patellar tendon. Such conditions include chronic patellar tendonitis, also known as jumper's knee, which can lead to tendon elongation over time. Additionally, it can be a sequelae of improper healing after a patellar tendon rupture, where the tendon heals in a lengthened position.

Diagnosis

Diagnosis of attenuated patella alta involves a combination of patient history, physical examination, and imaging studies. Clinically, patients may present with symptoms of instability, pain around the kneecap, or a history of patellar dislocations. On physical examination, a high-riding patella may be palpable. Imaging, particularly lateral view X-rays of the knee, is crucial for diagnosis. The Caton-Deschamps index, Insall-Salvati ratio, and Blackburne-Peel ratio are commonly used radiographic measurements to quantify patella alta. MRI may also be utilized to assess the integrity of the patellar tendon and associated structures.

Treatment

Treatment of attenuated patella alta focuses on addressing the underlying cause and relieving symptoms. Conservative treatment may include physical therapy aimed at strengthening the quadriceps and hamstring muscles to improve patellar tracking. Orthotic devices may also be used to stabilize the patella. In cases where conservative management fails to relieve symptoms or in the presence of recurrent patellar dislocations, surgical intervention may be considered. Surgical options include shortening of the patellar tendon, medial patellofemoral ligament (MPFL) reconstruction, or tibial tubercle transfer, depending on the specific pathology and alignment issues.

Prognosis

The prognosis for individuals with attenuated patella alta varies depending on the severity of the condition and the success of treatment. With appropriate management, many individuals can achieve good functional outcomes and return to their normal activities. However, some may continue to experience symptoms or require surgical intervention.

See Also

• Patellofemoral pain syndrome
• Chondromalacia patellae
• Patellar dislocation
• Patellar tendonitis