title: Treatment of patella alta in patients with episodic patellar dislocation: a systematic review.
abstract: OBJECTIVE
  While there are numerous anatomic contributors to patellar instability, the role of patella alta has been traditionally under-appreciated. The goal of this systematic review is to identify the described techniques for treating patella alta in skeletally mature patients with episodic patellar dislocation (EPD) and review their published results.
  
  
  METHODS
  A comprehensive literature review was performed to identify published surgical techniques and their results. Tibial tubercle distalization is the primary described treatment for patellar alta in patients with EPD, and five studies reporting results of this procedure were reviewed.
  
  
  RESULTS
  Tibial tubercle distalization was generally successful in normalizing patellar height and preventing recurrent patellar dislocation. Physical examination tests for instability such as patellar apprehension remained positive in 15 to 33% of patients. Patient-reported outcomes were rarely reported and difficult to interpret given the lack of pre-operative values or comparison groups.
  
  
  CONCLUSIONS
  Tibial tubercle distalization is an effective technique for correction of patellar height and preventing recurrent patellar dislocations. More comparative studies are required to evaluate patient-reported outcomes of this technique, the effect of an associated tubercle medialization, and the results of supplementing distalization with procedures such as MPFL reconstruction.
  
  
  METHODS
  Systematic review of case series, Level IV.
authors: Department of Orthopaedic Surgery, Sports Health and Performance Institute, The Ohio State University, Columbus, OH, USA, robert.magnussen@gmail.com.
authors: Robert A
authors: RA
authors: Magnussen
authors: Vito
authors: V
authors: De Simone
authors: Sebastien
authors: S
authors: Lustig
authors: Philippe
authors: P
authors: Neyret
authors: David C
authors: DC
authors: Flanigan
mesh_terms: D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D010329:Patella; D031222:Patellar Dislocation / Q000601:surgery*; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome
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