Patella alta is an under-recognized problem in patients with patellar instability and patellofemoral pain. Patella alta involves a patella that rides abnormally high in relation to the femur, the femoral trochlea, or the tibia. Patella alta is a risk factor for instability because the patella insufficiently engages the proximal trochlear groove during extension and early knee flexion. Patella alta is present in 30% of patients with a recurrent patella dislocation. Although patella alta may predispose patients to patellofemoral pain and instability, it may be a normal variant of a patient’s knee anatomy and may be well tolerated if other instability factors are not present. Many methods, with varied definitions, descriptions, and cutoff values, can be used to measure patellar height. The Caton-Deschamps index (CDI) is the most accurate diagnostic method and is the most useful for describing patellar height after distalization of the tibial tubercle. Surgery should be considered in patients with patella alta who are symptomatic and have exhausted nonsurgical treatment strategies. In the evaluation of a patient with patellofemoral pain or instability, a provider must understand the patient’s specific pathology and create a personalized treatment plan to address all anatomic abnormalities. Tibial tubercle anteromedialization and distalization and arthroscopic lateral release is a safe and reliable method for the management of patella alta in patients with lateral patellar tilt and lateral patellar chondral lesions.

This video demonstrates the technique for tibial tubercle anteromedialization and distalization and arthroscopic lateral release in a patient with patella alta, lateral patellar tilt, and a lateral patellar chondral lesion. The patient is a 22-year-old woman with a history of patella alta. The patient experienced patellofemoral pain for years and has undergone physical therapy, bracing, and the use of anti-inflammatories without pain relief. Imaging studies revealed patella alta with a Canton-Deschamps index of 1.5, lateral patellar tilt, and a lateral patellar chondral defect. This video provides an overview of the pathogenesis, diagnosis, and management of patella alta in patients with patellofemoral pathology. In the patient shown in this video, tibial tubercle anteromedialization and distalization and arthroscopic lateral release were performed. Excellent correction of patellar height and patellofemoral tracking was achieved. The osteotomy site healed uneventfully. The patient was advanced through a standardized rehabilitation protocol with gradual relief of her symptoms. Patellofemoral pain in patients with patella alta, lateral patellar tilt, and lateral patellar chondral lesions in whom nonsurgical treatment fails can be successfully managed via tibial tubercle anteromedialization and distalization and arthroscopic lateral release. This procedure specifically addresses all anatomic abnormalities and restores normal patellofemoral anatomy and biomechanics.