Patella Alta Sees You, Do You See It?

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Sports Medicine

Background:

• Patellar instability is multifactorial, with patellar height being a significant, often overlooked, factor.
• Tibial tubercle distalization osteotomy (TTDO) is a surgical option for correcting patellar instability related to patellar height.

Purpose of the Study:

• To clarify the indications for performing a TTDO in managing patellar instability.
• To outline patient, physical examination, and radiographic factors influencing the decision for TTDO.

Main Methods:

• Review of anatomic factors contributing to patellar instability.
• Evaluation of radiographic measures, including the Caton-Deschamps Index (CDI).
• Consideration of clinical findings like trochlear dysplasia and patellar maltracking.

Main Results:

• TTDO is generally indicated when the CDI exceeds 1.4, especially with medial patellofemoral ligament reconstruction.
• Lower CDI may still warrant TTDO if other factors like trochlear dysplasia, J-sign, or MRI findings are present.

Conclusions:

• The decision for TTDO requires a comprehensive assessment of patient-specific factors, clinical signs, and imaging.
• Careful surgical technique is crucial due to the frequency of complications associated with distalization osteotomies.