PATELLA ALTA AS AN ACTUAL RISK FACTOR OF PATELLOFEMORAL INSTABILITY: ASPECTS OF ETIOLOGY, BIOMECHANICS, DIAGNOSIS AND TREATMENT (LITERATURE REVIEW)

Introduction. Patella alta or high-riding patella is important and independent risk factor of patellar instability and can lead to development of pathologies of knee joint: patellar dislocation, osteoarthritis, patellar tendinopathy, patellofemoral pain syndrome, rupture of the anterior cruciate ligament and Osgood-Schlatter disease.
Materials and methods. Our research includes data analysis of literature of PubMed and Russian national electronic scientific library eLIBRARY with the aim of assessing the prevalence of patella alta, specificities of the influence of this risk factor to the biomechanics of the knee joint and to the development of patellofemoral joint instability, diagnostic methods, further methods of complex treatment and the possibility of returning to sports activities at the professional level (especially in physically active children).
Conclusion. Clinical and radiological diagnostics of patella alta doesn’t present difficulties. Reliable radiological indexes have been determined – modified Insall – Salvati index and Caton – Deschamps index. The last one has shown high reliability in children as well. In most cases patella alta is not isolated risk factor and it is observed in the combination with the most common risk factors of patellar instability.
The comprehensive approach is required in the study of patella alta in various pathologies of the knee joint, conservative treatment and the differential approach to a surgery of patellar dislocation with this risk factor between the reconstruction of the medial patellofemoral ligament, or combined reconstruction of the medial patellofemoral ligament and the medial patellotibial ligament, or distalization of the tuberosity of the tibia, or imbrication of the patellar tendon.

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