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. 2021 May 25;1(3):26350254211006699.
doi: 10.1177/26350254211006699. eCollection 2021 May-Jun.

Patellar Tendon Imbrication

Sercan Yalcin  1 , Ronak M Patel  2 , Jack Andrish  1 , Lutul D Farrow  1
Affiliations

Patellar Tendon Imbrication

Sercan Yalcin et al. Video J Sports Med. .

Abstract

Background: Patella alta is a common cause of patellar instability. Patellar tendon imbrication is a successful surgery addressing the deformity by shortening the patellar tendon without necessitating an osteotomy.

Indications: Symptomatic patella alta causing patellar instability in both skeletally immature and adult patients.

Technique description: The patellar tendon is exposed, and levels of imbrication as determined preoperatively by radiographic measurements are outlined on the tendon with a marking pen. A third line is then made proximal to the level of dissection that is half the distance of the lengthening. From the distal marking, a flap of tendon, the anterior half, is elevated by sharp dissection using a fresh No. 15 blade proximal to the predetermined level. Next, "redundancy-reducing" 2-0 vicryl sutures are placed and left untied by entering at the proximal marking, passing deep to the tendon, and emerging at the middle of the intact posterior section of tendon, followed by placement of 3 structural #2 Ethibond/Ti-Cron horizontal sutures into the patellar tendon that will create and maintain the imbrication. These sutures are then tied proximally while applying downward pressure to the patella to avoid tying under tension. Next, the "redundancy-reducing" sutures are tied thus imbricating the redundant posterior section of tendon. In a "pants over vest" fashion, the distal end of the anterior section of isolated tendon is repaired with ''0'' absorbable suture. The knee is then flexed beyond 90° to assess competence of the suture lines and to assess the need for quadriceps lengthening.

Results: Radiographic shortening is maintained at a minimum of 2 years on 27 patients/32 knees. There were no complications directly related to the technique.

Discussion/conclusion: Patellar tendon imbrication is a safe and effective procedure to correct patella alta in the setting of lateral patellar instability. On average, the technique allowed 1 cm of patellar tendon shortening and maintained the correction at a minimum 2-year follow-up. In the skeletally immature patient, this technique allows correction of patella alta by avoidance of a tibial tuberosity osteotomy.

Keywords: patella alta; patellar dislocation; patellar instability; patellar tendon imbrication; patellar tendon shortening.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: R.M.P receives food, beverage, travel, and lodging support from Smith & Nephew; education support from Arthrex and Medwest Associates; consulting fees from Daiichi Sankyo Inc and Ceterix Orthopaedics Inc; honoraria from Fidia Pharma USA Inc, travel and lodging support from Arthrosurface Incorporated; and payments for services other than consulting from Sanofi-Aventis US LLC. L.D.F. receives food, beverage, travel, and lodging support from Musculoskeletal Transplant Foundation Inc. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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