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Patella Baja: Causes, Symptoms & Treatment

Patella baja describes an abnormally low-lying kneecap. It can cause knee pain, restricted movement, and joint dysfunction.

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Things worth knowing about "Patella baja"

Patella baja describes an abnormally low-lying kneecap. It can cause knee pain, restricted movement, and joint dysfunction.

What Is Patella Baja?

Patella baja (also referred to as patella infera) is a condition in which the kneecap (patella) is positioned abnormally low in relation to the knee joint. Unlike the normal alignment, the kneecap sits too far downward, which can impair the normal function of the knee joint. The term originates from Latin: "patella" means kneecap, and "baja" means low.

Causes

Patella baja can develop from a variety of causes. It most commonly arises as a complication following knee surgery or trauma:

Postoperative scarring: After knee procedures such as anterior cruciate ligament reconstruction or total knee replacement, scar tissue and fibrosis can pull the kneecap downward.
Patellar tendon shortening: Shortening or fibrosis of the patellar tendon is one of the most frequent underlying causes.
Infrapatellar contracture syndrome: Scarring of the fat pad beneath the kneecap (Hoffa fat pad) can also contribute to patella baja.
Prolonged immobilization: Extended immobilization of the knee following injury or surgery.
Chronic inflammation: Rheumatic conditions may play a role in rare cases.
Congenital causes: In rare instances, the low kneecap position is present from birth.

Symptoms

Symptoms of patella baja can vary depending on severity. Common complaints include:

Pain in the front of the knee, particularly when climbing stairs, kneeling, or squatting
Reduced range of motion in the knee (especially with bending)
Swelling and stiffness of the knee joint
A feeling of instability in the knee
Muscle wasting (atrophy) of the quadriceps muscle due to altered movement patterns
Grinding or clicking sensations during knee movement (crepitus)

Diagnosis

Diagnosis of patella baja is based on clinical assessment and imaging studies:

Clinical Examination

The physician evaluates the range of motion of the knee, palpates the kneecap, and assesses muscle strength and joint stability.

Imaging Studies

X-ray: The standard method for assessing kneecap position. Standardized measurement indices such as the Insall-Salvati index or the Caton-Deschamps index are used to determine the relationship between patellar tendon length and kneecap position. A value below 0.8 is generally considered indicative of patella baja.
MRI (Magnetic Resonance Imaging): Provides detailed information about soft tissue structures, scarring, and cartilage condition.
Ultrasound: Can be used to assess the patellar tendon and surrounding soft tissues.

Treatment

Treatment depends on the severity of the condition and the symptoms experienced by the patient.

Conservative Treatment

Physiotherapy: A targeted exercise program to improve knee mobility, stretch the patellar tendon, and strengthen surrounding muscles.
Manual therapy: Mobilization of the kneecap performed by specialized physiotherapists.
Pain management: Use of anti-inflammatory medications (e.g., NSAIDs) as needed.
Orthoses and assistive devices: Specialized knee braces may help support joint function.

Surgical Treatment

In severe cases or when conservative measures are insufficient, surgery may be necessary:

Scar release (arthrolysis): Arthroscopic or open removal of scar tissue and adhesions to restore kneecap mobility.
Patellar tendon lengthening: Surgical lengthening of the patellar tendon in cases of severe shortening.
Tibial tubercle transfer: In selected cases, the bony attachment of the patellar tendon (tibial tuberosity) may be surgically repositioned.

Prognosis

The prognosis for patella baja depends on the underlying cause, severity, and timing of treatment. Early physiotherapy following knee surgery can effectively prevent the development of patella baja. When treated promptly, significant improvement in symptoms and joint function is achievable in many cases.

References

Insall J, Salvati E. - Patella position in the normal knee joint. Radiology. 1971;101(1):101-104.
Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. - Patella infera. A propos of 128 cases. Revue de Chirurgie Orthopédique. 1982;68(5):317-325.
Maffulli N, Longo UG, Denaro V. - Novel approaches for the management of tendinopathy. Journal of Bone and Joint Surgery. 2010;92(15):2604-2613.

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