New technique for knee flexion contracture with patella infera using patellar tendon reconstruction combined with anterior capsular shift: a case report

Abstract

A 24-year-old male presented with an open fracture of the left patella (Gustilo-Anderson grade III-A) and fracture of the left femoral lateral condyle, and subsequent patella alta suggesting rupture of the left patellar tendon. This initial injury was treated 6 months earlier in another hospital. He was referred because of limited knee motion and radiographs showed severe patella infera. By means of a combination of a contralateral BTB graft and soft tissue repair named anterior capsular shift, the knee contracture with patella infera was resolved successfully.

Treatment of patella baja by a modified Z-plasty

“…Patella baja is a severe complication of knee surgery [1, 3–9, 12–21, 23–28, 30, 31]. Primary and secondary causes or intrinsic and extrinsic factors have been described in the development of patella baja [17, 18, 30].…”

“…All four patients presented with an acquired type of patella baja and were representative of the most common index traumas described in the literature [3, 4, 9, 12, 17–20]. Several operative techniques have been published, with varying outcomes [2–6, 9, 13, 14, 18, 19, 26, 27].…”

“…In et al [13] used the Ilizarov technique, whereas others [14, 27, 31] described a contralateral patellar tendon autograft or various allografts. However, as the availability of allografts is limited in several countries, patellar tendon lengthening and tibial tuberosity transfer are popular methods.…”

“…Patella baja, also called patella infera, frequently occurs in combination with arthrofibrosis following knee surgery, especially in the context of infrapatellar contracture syndrome (IPCS) [1, 3–9, 12–21, 23–28, 30, 31].…”

Frontal Tendon Lengthening Plasty for Treatment of Structural Patella Baja

“…Concerning the soft tissue procedures, different options for the lengthening of the patellar tendon using autografts such as a contralateral bone tendon bone graft 7 or allografts 8 have been described. In et al 9 described the lengthening of the patellar tendon by using the Ilizarov technique.…”