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Patellar Instability Secondary to Patella Alta in Total Knee Arthroplasty: A Case Report

Neil Jain¹, Brendan Smith, Tyler Smith

¹Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania.

JBJS Case Connector

|July 24, 2025

Abstract

Case:

Prior evidence has suggested that patellar height does not significantly affect clinical and radiologic outcomes after total knee arthroplasty (TKA). We present a 65-year-old woman with native patella alta who developed pain, patellar instability, and global instability after TKA. A J-sign was present as the patella engaged the trochlear component at 30° of flexion. As such, a tibial tubercle osteotomy (TTO) was used to distalize the patella. At 1-year follow-up, the patient had returned to her normal activities of daily living without difficulty.

Conclusion:

Patellar instability secondary to patella alta in TKA may be managed with TTOs.

Keywords:

patella alta patellar instability tibial tubercle osteotomy total knee arthroplasty

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The femur is the body's longest and strongest bone spanning the thigh region. Its head articulates with the acetabulum of the hip bone to form the hip joint. A minor indentation on the medial side of the femoral head, called the fovea capitis, serves as the site of attachment for the ligament of the head of the femur. This weak ligament spans the femur and acetabulum and supports the hip joint. The narrowed region below the head is the neck of the femur. The inclination angle between the...

Knee Joint

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A total of seven ligaments support the knee joint. The patellar ligament, which is also attached to the quadriceps femoris...

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