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Patellar Tendon Imbrication

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Anterior Knee Pain and Patellar Instability

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Abstract

Recurrent patellar dislocations are not uncommon. The factors contributing to patella instability are multifactorial, but one of the most common risk factors is patella alta. A tibial tuberosity osteotomy has been the standard approach in correcting patella alta. However, this procedure cannot be used on the skeletally immature due to an open apophysis. This chapter describes a surgical method to correct patella alta through a patellar tendon imbrication. The procedure can be used on a skeletally immature patient as well as a mature patient as the tibial tuberosity is not interrupted. Recent clinical data shows that there is no significant loss of corrected patellar tendon length after a minimum of 2 years postoperatively after patellar tendon imbrication; this technique serves as an effective alternative in treating patella alta.

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References

  1. Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004;32(5):1114–21.

    Article  PubMed  Google Scholar 

  2. Amin NH, Lynch TS, Patel RM, Patel N, Saluan P. Medial patellofemoral ligament reconstruction. JBJS Rev. 2015;3(7):1–9.

    Article  Google Scholar 

  3. Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C. Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med. 2000;28(4):472–9.

    Article  CAS  PubMed  Google Scholar 

  4. Quirbach S, Smekal V, Rosenberger RE, El Attal R. Scho¨ ttle PB. Anatomical double-bundle reconstruction of the medial patellofemoral ligament with a gracilis autograft [in German]. Oper Orthop Traumatol. 2012;24:131–9.

    Article  CAS  PubMed  Google Scholar 

  5. Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med. 2012;40:1916–23.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Gao G, Liu P, Xu Y. Treatment of patellar dislocation with arthroscopic medial patellofemoral ligament reconstruction using gracilis tendon autograft and modified double-patellar tunnel technique: Minimum 5-year patient-reported outcomes. J Orthopaed Surg Res. 2020;15(1). https://doi.org/10.1186/s13018-020-1556-4.

  7. McNeilan RJ, Everhart JS, Mescher PK, Abouljoud M, Magnussen RA, Flanigan DC. Graft choice in isolated medial patellofemoral ligament reconstruction: a systematic review with meta-analysis of rates of recurrent instability and patient-reported outcomes for autograft, allograft, and synthetic options. Arthroscopy. 2018;34:1340–54.

    Article  PubMed  Google Scholar 

  8. Chilelli B, Patel R, Bhatia S, Das V. Surgical trends and reported complications of medial patellofemoral ligament reconstruction among board eligible orthopaedic surgeons: analysis of data over a 15 year period. Am J Sports Med. Forthcoming.

    Google Scholar 

  9. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994;2:19–26.

    Article  CAS  PubMed  Google Scholar 

  10. Biedert RM, Albrecht S. The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc. 2006;14:707–12. https://doi.org/10.1007/s00167-005-0015-4.

  11. Luyckx T, Didden K, Vandenneucker H, Labey L, Innocenti B, Bellemans J. Is there a biomechanical explanation for anterior knee pain in patients with patella alta? Influence of patellar height on patellofemoral contact force, contact area and contact pressure. J Bone Joint Surg Br. 2009;91:344–50.

    Article  CAS  PubMed  Google Scholar 

  12. Singerman R, Davy DT, Goldberg VM. Effects of patella alta and patella infera on patellofemoral contact forces. J Biomech. 1994;27:1059–65.

    Article  CAS  PubMed  Google Scholar 

  13. Stefanik JJ, Zhu Y, Zumwalt AC, et al. Association between patella alta and the prevalence and worsening of structural features of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study. Arthritis Care Res. 2010;62:1258–65.

    Article  CAS  Google Scholar 

  14. Ward SR, Terk MR, Powers CM. Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. J Bone Joint Surg Am. 2007;89:1749–55.

    PubMed  Google Scholar 

  15. Mayer C, Magnussen RA, Servien E, Demey G, Jacobi M, Neyret P, et al. Patellar tendon tenodesis in association with tibial tubercle distalization for the treatment of episodic patellar dislocation with patella alta. Am J Sports Med. 2012;40:346–51. https://doi.org/10.1177/0363546511427117.

  16. Payne J, Rimmke N, Schmitt LC, Flanigan DC, Magnussen RA. The incidence of complications of tibial tubercle osteotomy: a systematic review. Arthroscopy. 2015;31:1819–25. https://doi.org/10.1016/j.arthro.2015.03.028.

  17. Sherman SL. Tibial tubercle osteotomy that includes distalization has higher reoperation and revision rates. Healio Medblog; 2018. https://www.healio.com/news/blogs/%7Bd0aa44d3-00d3-4b42-beef-660d11561766%7D/patellofemoral-update/blog-tibial-tubercle-osteotomy-that-includesdistalization-has-higher-reoperation-and-revision-rates.

  18. Andrish J. Surgical options for patellar stabilization in the skeletally immature patient. Sports Med Arthrosc Rev. 2007;15(2):82–8. https://doi.org/10.1097/jsa.0b013e31805752d0.

    Article  PubMed  Google Scholar 

  19. Neyret P, Robinson AHN, Le Coultre B, Lapra C, Chambat P. Patellar tendon length—the factor in patellar instability? Knee. 2002;9:3–6.

    Article  PubMed  Google Scholar 

  20. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot. 1982;68:317–25.

    Google Scholar 

  21. Blackburne JS, Peel TE. A new method of measuring patellar height. J Bone Joint Surg Br. 1977;59:241–2.

    Article  CAS  PubMed  Google Scholar 

  22. Insall J, Salvati E. Patella position in the normal knee joint. Radiology. 1971;101:101–4. https://doi.org/10.1148/101.1.101.

  23. Andrish J. Patellar tendon shortening. In: Dejour D, Zaffagnini S, Arendt E, Sillanpää P, Dirisamer F, editors. Patellofemoral pain, instability, and arthritis. 2nd ed. Springer; 2020. p. 551–6.

    Chapter  Google Scholar 

  24. Yalcin S, Patel RM, Andrish J, Farrow LD. Patellar tendon imbrication. Video J Sports Med. 2021;1(3):263502542110066. https://doi.org/10.1177/26350254211006699.

    Article  Google Scholar 

  25. Patel RM, Gombosh M, Polster J, Andrish J. Patellar tendon imbrication is a safe and efficacious technique to shorten the patellar tendon in patients with patella alta. Orthop J Sports Med. 2020;8(10):232596712095931. https://doi.org/10.1177/2325967120959318.

    Article  Google Scholar 

  26. Parvaresh KC, Huddleston HP, Yanke AB. Patellar tendon shortening for treatment of patella alta in skeletally immature patients with patellar instability. Arthrosc Techniq. 2021;10(8). https://doi.org/10.1016/j.eats.2021.04.025.

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Authors and Affiliations

  1. Illinois Center for Orthopaedic Research and Education, 550 W. Ogden Ave, Hinsdale, IL, 60521, USA

    Ronak M. Patel

  2. University of Illinois College of Medicine at Chicago, Chicago, IL, USA

    Sneh Patel

  3. The Cleveland Clinic Foundation, Cleveland, OH, USA

    Jack Andrish

Authors
  1. Ronak M. Patel
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  2. Sneh Patel
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  3. Jack Andrish
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Correspondence to Ronak M. Patel .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain

    Vicente Sanchis-Alfonso

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Patel, R.M., Patel, S., Andrish, J. (2023). Patellar Tendon Imbrication. In: Sanchis-Alfonso, V. (eds) Anterior Knee Pain and Patellar Instability. Springer, Cham. https://doi.org/10.1007/978-3-031-09767-6_32

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  • DOI: https://doi.org/10.1007/978-3-031-09767-6_32

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-09766-9

  • Online ISBN: 978-3-031-09767-6

  • eBook Packages: MedicineMedicine (R0)

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