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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 9, pp 2943–2947 | Cite as

Treatment of patella baja by a modified Z-plasty

  • Wierer Guido
  • Hoser Christian
  • Herbst Elmar
  • Abermann Elisabeth
  • Fink Christian
Knee

Abstract

Purpose

The purpose of this study was to evaluate the efficiency of a modified Z-plasty for patellar tendon lengthening for the treatment of patella baja. Rather than adapting only two tendon reins according to the conventional Z-plasty method, the modified Z-plasty provides four reins to enable multifold overlapping of the tendon tissue.

Methods

Between 2010 and 2012, a modified Z-plasty procedure was performed in four patients suffering from patella baja. Physical examinations and standardized scoring instruments served as the evaluation measures.

Results

The median preoperative CD ratio of 0.53 (range 0.43–0.62) was corrected to 1.03 (range 1–1.06) after a median follow-up of 34 months (range 23–41 months). The median preoperative flexion of 108° (range 80–135°) improved to 143° (range 110–145°) compared with the flexion of 145° (range 140–145°) of the unaffected knee. No patients showed any signs of extension lag. The median Lysholm score improved from 49 (range 22–80) to 91 (range 67–95), and the Tegner activity level improved from 2 (range 0–6) to 6 (range 2–6). The median VAS status for pain decreased from an average of 8.5 (range 4–10) to 1 (range 0–2). No complications were observed.

Conclusion

The modified Z-plasty procedure is a valuable technique for the treatment of patella baja, especially if allografts are not available. This procedure allowed for early mobilization and achieved excellent clinical results.

Level of evidence

IV.

Keywords

Patella baja Patella infera Infrapatellar contracture syndrome Patellar tendon lengthening Z-plasty 

Notes

Acknowledgments

We thank Caroline Hepperger from the OSM Research Foundation for her highly motivated contribution in collecting the clinical data used for this study.

References

  1. 1.
    Ahmad CS, Kwak SD, Ateshian GA, Warden WH, Steadman JR, Mow VC (1998) Effects of patellar tendon adhesion to the anterior tibia on knee mechanics. Am J Sports Med 26(5):715–724PubMedGoogle Scholar
  2. 2.
    Burge JR, Sanchez HB, Wagner RA (2014) Quadriceps and patellar tendon pie-crusting as a treatment for limited flexion in total knee arthroplasty. Am J Orthop 43(4):E83–E88PubMedGoogle Scholar
  3. 3.
    Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68(5):317–325PubMedGoogle Scholar
  4. 4.
    Caton JH (2010) The management of patella infera in current practice. Eur J Orthop Surg Traumatol 20:365–371CrossRefGoogle Scholar
  5. 5.
    Caton JH, Dejour D (2010) Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop 34:305–309CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Dejour D, Levigne C, Dejour H (1995) Postoperative low patella. Treatment by lengthening of the patellar tendon. Rev Chir Orthop Reparatrice Appar Mot 81(4):286–295PubMedGoogle Scholar
  7. 7.
    Drexler M, Dwyer T, Marmor M, Sternheim A, Cameron HU, Cameron JC (2013) The treatment of acquired patella baja with proximalize the tibial tuberosity. Knee Surg Sports Traumatol Arthrosc 21(11):2578–2583CrossRefPubMedGoogle Scholar
  8. 8.
    Fink C, Hausberger M, Hoser C (2012) Combined anterior cruciate ligament reconstruction with patella tendon lengthening following a complex knee injury. In: Sanchis-Alfonso V, Monllau-Garcia JC (eds) The ACL-deficient knee: a problem solving approach. Springer, London, pp 321–328Google Scholar
  9. 9.
    Freiling D, Galla M, Lobenhoffer P (2006) Die Arthrolyse bei chronischen Beugedefiziten des Kniegelenks. Unfallchirurg 109:285–296CrossRefPubMedGoogle Scholar
  10. 10.
    Gideroglu K, Akan M, Orhun H, Bozdag E, Gül AE, Akgun E, Akoz T (2009) In vivo comparison of biomechanical, histological, and radiological properties of three techniques for tendon lengthening: an experimental study in rabbits. Scand J Plast Reconstr Surg 43(1):1–7CrossRefGoogle Scholar
  11. 11.
    Gideroglu K, Toksoy S, Akan M, Yildirim S, Sümbüloğlu E, Akoz T (2009) In-vitro comparison of the lengthening and biomechanical properties of three tendon lengthening techniques. Scand J Plast Reconstr Surg 20(2):107–113Google Scholar
  12. 12.
    Glinz W (1999) Bewegungseinschraenkung nach Trauma und Operationen am Kniegelenk. Arthroskopie 12:222–232CrossRefGoogle Scholar
  13. 13.
    In Y, Kim S-J, Kwon Y-J (2007) Patellar tendon lengthening for patella infera using the Ilizarov technique. J Bone Joint Surg Br 89(3):398–400CrossRefPubMedGoogle Scholar
  14. 14.
    Mariani PP (1994) A new surgical procedure for the treatment of patella infera. Knee Surg Sports Traumatol Arthrosc 21(2):238–241CrossRefGoogle Scholar
  15. 15.
    McReynolds JG, Meyer MH, Rea JB (2009) Infrapatellar contracture syndrome following ACL reconstruction. JAAPA 22(3):23–24, 26PubMedGoogle Scholar
  16. 16.
    Meyer SA, Brown TD, Pederson DR, Albright JP (1993) The effects of patella infera on patellofemoral contact stress. Trans Orthop Res Soc 18:303Google Scholar
  17. 17.
    Paulos LE, Rosenberg TD, Drawbert J, Manning J, Abbott P (1987) Infrapatellar contracture syndrome. An unrecognized cause of knee stiffness with patella entrapment and patella infera. Am J Sports Med 15(4):331–341CrossRefPubMedGoogle Scholar
  18. 18.
    Paulos LE, Wnorowski DC, Greenwald AE (1994) Infrapatellar contracture syndrome. Diagnosis, treatment, and long-term followup. Am J Sports Med 22(4):440–449CrossRefPubMedGoogle Scholar
  19. 19.
    Romero J, Borgeat A, Cartier P (1999) Patella baja. Arthroskopie 12:237–245CrossRefGoogle Scholar
  20. 20.
    Saggin PRF, Dejour D (2011) Patella Infera and Patella Alta. In: Sanchis-Alfonso V (ed) Anterior knee pain and patellar instability. Springer, London, pp 443–450CrossRefGoogle Scholar
  21. 21.
    Schön SN, Afifi FK, Rasch H, Amsler F, Friederich NF, Arnold MP, Hirschmann MT (2013) Assessment of in vivo loading history of the patellofemoral joint: a study combining patellar position, tilt, alignment and bone SPECT/CT. Knee Surg Sports Traumatol Arthrosc 22(12):3039–3046CrossRefPubMedGoogle Scholar
  22. 22.
    Seo JG, Moon YW, Kim SM, Park SH, Lee BH, Chang MJ, Jo BC (2014) Prevention of pseudo-patella baja during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-014-3257-1 Google Scholar
  23. 23.
    Shabshin N, Schweitzer ME, Morrison WB, Parker L (2004) MRI criteria for patella alta and baja. Skelet Radiol 33(8):445–450CrossRefGoogle Scholar
  24. 24.
    Singerman R, Davy DT, Goldberg VM (1994) Effects of patella alta and patella infera on patellofemoral contact forces. J Biomech 27(8):1059–1065CrossRefPubMedGoogle Scholar
  25. 25.
    Skutek M, Elsner H-A, Slateva K, Mayr H-O, Weig T-G, van Griensven M, Krettek C, Bosch U (2004) Screening for arthrofibrosis after anterior cruciate ligament reconstruction: analysis of association with human leukocyte antigen. Arthroscopy 20(5):469–473CrossRefPubMedGoogle Scholar
  26. 26.
    Sulaiman AR, Halim AS, Azman WS, Eskandar H (2008) Reconstruction of severe patellar infera syndrome with free vascularised composite tensor fascia lata flap. Singap Med J 49(8):205–207Google Scholar
  27. 27.
    Takai S, Shimazaki N, Yoshino N, Watanabe N, Nakachi N, Kobayashi M, Matsusita T (2009) New technique for knee flexion contracture with patella infera using patellar tendon reconstruction combined with anterior capsular shift: a case report. Arch Orthop Trauma Surg 129:1383–1386CrossRefPubMedGoogle Scholar
  28. 28.
    van Eijden TM, Kouwenhoven E, Weijs WA (1987) Mechanics of the patellar articulation. Effects of patellar ligament length studied with a mathematical model. Acta Orthop Scand 58(5):560–566CrossRefPubMedGoogle Scholar
  29. 29.
    Villanueva M, Luna A, Pereiro J, Fahandezh-Saddi H, Villa A (2006) Technical solutions for patella baja and arthrofibrosis after total knee replacement. Rev Esp Cir Traumatol Ortop 50:268–276CrossRefGoogle Scholar
  30. 30.
    Wojtys EM, Oakes B, Lindenfeld TN, Bach BR Jr (1997) Patella infera syndrome: an analysis of the patellar tendon pathology. Instr Course Lect 46:241–250PubMedGoogle Scholar
  31. 31.
    Yoo J-H, Chang J-D, Seo Y-J, Baek S-W (2011) Reconstruction of a patellar tendon with Achilles tendon allograft for severe patellar infera—a case report. Knee 18(5):350–353CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Wierer Guido
    • 1
    • 2
  • Hoser Christian
    • 1
  • Herbst Elmar
    • 1
    • 3
  • Abermann Elisabeth
    • 1
  • Fink Christian
    • 1
  1. 1.Sportsclinic Austria, InnsbruckInnsbruckAustria
  2. 2.Department of Traumatology and Sports InjuriesParacelsus Medical University, SalzburgSalzburgAustria
  3. 3.Department of Orthopaedic Sports MedicineTechnical University MunichMunichGermany

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