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Introduction

Knee Pain

Patella Alta

The patella, or kneecap, is a small, inverted (upside down) triangular bone that sits at the front of the knee.

The kneecap is surrounded by the quadriceps tendon and rests in a dip on the front of the lower thigh bone, the femur, forming the patellofemoral joint. This dip is known as the patellofemoral groove, aka patella groove, trochlear groove or intercondylar groove. As the knee moves, the patella slides up and down this groove.

The patellar tendon comes out from the bottom of the kneecap and connects the kneecap to the shin bone, the tibia.

In patella alta, the kneecap sit higher than normal in the patella groove. Here, the groove is much shallower than further down, thus providing only a very small barrier each side of the kneecap.

As a result, the groove provides very little sideways stability for the kneecap.

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Causes

Patella Alta is what is known as an idiopathic condition, meaning that the cause of high riding patella is typically unknown. The common causes of patella alta are:

  • Congenital Defect: In most cases, patella alta is present from birth and likely occurred during embryonic development 

  • Long Patellar Tendon: People with abnormally long patellar tendons, >52mm, often suffer from patella alta 

  • Knee Injuries: Patella alta may develop after a knee injury, typically kneecap dislocation 

  • Cerebral Palsy: Patella alta is a common abnormality with cerebral palsy, especially in children who walk with bent knees

Symptoms

Typical symptoms of patella alta include:

  • Instability: People with patella alta often complain that their knee feels weak or unstable, particularly when walking or running

  • Recurrent Kneecap Dislocation: knee dislocation is a common problem for people with a high riding patella. Some people can push their kneecap in and out of position in the patellar groove at will causing it to dislocate and then relocate

  • Anterior Knee Pain: pain at the front of the knee, aka patellofemoral pain, is common with patella alta, especially when walking up and down slopes, squatting, sitting for prolonged periods and on stairs

Diagnosis

To diagnose patella alta, your doctor will start by examining your knee. They will look at the position of the kneecap in relation to the femur from different angles and with the knee in different positions. 

Non-surgical treatments

Treatment for patella alta aims to reduce knee pain and instability and restore full knee function. 

Non-operative treatment for a high riding patella will include:

  • Rest: from aggravating activities to allow any inflammation to settle 

  • Strengthening Exercises: strengthening the knee, kneecap and buttock muscles can help to correct patella position and thus reduce pain and improve knee stability with a high riding patella - see knee strengthening exercises 

  • Physical Therapy: Manual therapy can help to improve the resting position of the kneecap 

  • Patellar Taping: taping can also help to correct the position of the patella 

  • Ice Packs: regularly applying ice packs can help reduce pain and inflammation with symptomatic patella alta - see the ice wraps section 

  • Knee Brace: wearing a brace can help to reduce the symptoms of a high riding patella. Ideally, the brace should have a tubular section which sits above the kneecap to stop it riding up - see the knee brace section

Surgery