Patella baja was first described by Trillat in 1973, at which time it was termed patella infera. Patella baja is congenital or acquired. Congenital patella baja often is associated with other skeletal malformations and usually does not require management. Acquired patella baja most often occurs secondary to trauma or surgical procedures, such as acromioclavicular ligament reconstruction and total knee arthroplasty. Disruption of the patellar tendon leads to scarring and shortening, fibrosis of the infrapatellar fat pad, and intra-articular adhesions. Clinically, patients with patella baja have restricted range of motion, anterior knee pain, gait abnormalities, and an extensor lag. Management of patella baja typically begins with physical therapy followed by manipulation under anesthesia and arthroscopic lysis of adhesions. For patients in whom these modalities fail, treatment typically consists of a bony procedure, such as tibial tubercle osteotomy with proximalization, a soft-tissue procedure, such as patellar tendon lengthening, or both procedures.

This video provides an overview of patella baja and demonstrates the surgical technique for tibial tubercle osteotomy and proximalization. The video provides an overview of the anatomy, biomechanics, pathogenesis, diagnosis, and management of chronic patella baja followed by a discussion of the indications for tibial tubercle osteotomy and patellar tendon lengthening. The video discusses the case presentation of a 53-year-old man with posttraumatic patella baja. The patient previously underwent aggressive physical therapy, arthroscopic lysis of adhesions, and manipulation under anesthesia but experienced little resolution of his symptoms. Therefore, tibial tubercle osteotomy with proximalization was indicated. Restoration of the patellar height as well as improved knee flexion and decreased extensor lag were achieved. Tibial tubercle osteotomy and proximalization is a reliable treatment option for patients with chronic patella baja. Although several treatment options for the management of patella baja are discussed in the literature, a paucity of studies include long-term follow up. This video reviews the available treatment options and their respective results.