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.
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
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
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.
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
In severe cases of patella alta where the kneecap keep dislocating, or when conservative treatment fails, then surgery is necessary to effectively treat the condition. There are a number of different surgical options for patella alta:
Tibial Tuberosity Osteotomy: aka Tibial Tubercle TransferThis is when then patellar tendon attachment is moved down, which in turn brings the patella down with it. The Q angle can also be corrected if necessary by moving the patellar tendon attachment inwards. A tibial tuberosity osteotomy is done by removing the tibial tuberosity from the front of the shin bone, moving it down and reattaching it in its new position with a screw and wires.
Lateral Release: If tightness in the structures on the outer side of the knee are pulling the kneecap out of position with a high riding patella then lateral release surgery can be carried out to loosen them. Find out what surgery involves in the lateral release section.
Patellectomy: This is where the patella is completely removed and is only indicated when other surgical methods have failed or where there is severe patellofemoral arthritis
Following surgery for patella alta you will:
Wear A Knee Brace: A hinged knee brace is usually worn for up to six weeks following surgery. The brace will limit the amount of flexion at the knee to allow it to heal properly
Use Crutches: For the first couple of weeks you will only take minimal weight through the operated leg so will need to use crutches. You will then gradually be able to increase the weight through the leg over the next few weeks. Most people are off crutches by around six weeks. Check out our top tips for using crutches on the stairs
Have Physical Therapy: Once you are allowed to start moving your knee, you will start physical therapy to help to regain full strength, stability, movement and function in your knee. By around 3 months you can start gentle impact activities such as lunges and then progress on to gentle jogging.
It usually takes around six months to fully recover from patella alta surgery and get back to high impact activities and sports.
How using the HeatPulse
and Thermosleeve can help
The Thermosleeve and HeatPulse are great tools for hot and cold therapy to help you recover from your surgery.
Thermosleeve combines cold with compression for greater effectiveness in relieving pain and inflammation
HeatPulse combines heat and massage to boost blood flow to your knee, encouraging healing and improving range of motion
Swelling after knee surgery can last for three to six months after surgery. To help reduce inflammation and pain, you can use the Thermosleeve three to four times a day for about 10-20 minutes during the first few days after surgery.
After the initial swelling has gone down, you can alternate between the Thermosleeve and the HeatPulse to relax the muscles and ease stiffness.
The Thermosleeve and HeatPulse are great tools for hot and cold therapy to help you recover from your surgery.
Thermosleeve combines cold with compression for greater effectiveness in relieving pain and inflammation
HeatPulse combines heat and massage to boost blood flow to your knee, encouraging healing and improving range of motion
Swelling after knee surgery can last for three to six months after surgery. To help reduce inflammation and pain, you can use the Thermosleeve three to four times a day for about 10-20 minutes during the first few days after surgery.
After the initial swelling has gone down, you can alternate between the Thermosleeve and the HeatPulse to relax the muscles and ease stiffness.
Hear from customers
who have experienced relief
