Management of Patella Alta with Semitendinosus Graft in Cerebral Palsy Patients

Document Type : Original Article

Authors

Department of Orthopedic Surgery, Faculty of Medicine, Helwan University, Cairo, Egypt.

Abstract

Introduction
Patella alta is a pathological condition where the patellar is superiorly displaced, this can lead to associated anterior knee pain and decreased strength of the extensor mechanism. Pediatric patients with cerebral palsy have a higher incidence rate of patella alta, and this is thought to be a cause of anterior knee pain and weakness of knee extension in those patients In this study, we harvested the semitendinosus tendon and utilized it as a tension band to correct the patella’s position. This approach eliminates the need for additional hardware and reduces the flexion strength of the hamstrings, achieving a dual effect.
Subjects and Methods
A prospective cohort study was conducted on 20 cases, ages ranging from 10 to 15 years. 16 cases were level III by the gross motor function classification system, while 4 cases were gross motor function classification system level II, and all cases were diplegic cerebral palsy. All of them were managed by semimembranosus muscle fractional lengthening and harvesting the semitendinosus tendon and utilizing it as a tension band to correct the patella’s position.
Results
There was a statistically significant improvement in the patella position and the gait postoperatively.
Conclusion
The semitendinosus tendon used as a tension band for correction of the patella allows correction of both patella positions as well as improving gait pattern. Level of evidence: case series (IV).

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