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Patella Baja: The Most Common Knee Condition Nobody Knows About
by Mike McClellan
Constant pain in the front and center of your knee. The inability to bend your knee into a crouched position. Not enough leg strength to stand up from a crouched position. Does this sound familiar? If so, there’s a chance you may have Patella Baja.
Patella Baja
Patella Baja is a condition where the knee cap is positioned too low. It can make bending your leg past 90 degrees difficult to impossible. As if this lack of mobility isn’t bad enough, it will also usually lead to weak leg muscles. More specifically, weak quadriceps muscles.
Quadriceps Weakness
With your knee cap sitting so low, the tendon above your knee is constantly being stretched more than it should, just to reach your knee cap. When you bend your leg farther and farther, it continues to stretch that tendon even more, and eventually it just refuses to stretch any more, usually around 90 degrees. If your leg can’t bend past 90 degrees, then any leg exercise you might do is only going to be strengthening over a limited range of motion. This may allow you to fairly comfortably sit up from a high seated-chair, but crouching down to pick something up isn’t an activity you would attempt in your wildest dreams.
Total Knee Arthroplasty (Knee Replacement) Patients
People who have had previous knee injuries, from bone fractures to tendon/ligament tears, are at an increased risk of developing Patella Baja. You may think you’re out-of-the-woods if you’ve had a TKA (Total Knee Arthroplasty), but that’s far from the truth. Surprisingly enough, people who have had a total knee replacement have a higher increased risk of developing Patella Baja. Studies have found that the prevalence of the condition occurs in anywhere from 25-34% of TKA patients. This typically starts a month after surgery, and progressively worsens for up to four (4) years post-surgery.
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What often happens is after an individual has a TKA, they go through at home and clinical physical therapy. Once that is complete, after typically 4-8 weeks, they return to a mostly sedentary lifestyle. The longer they are inactive, the weaker their quadriceps muscles become. And the farther their knee cap will continue to drop. After a while the knee cap drops so far that the quadriceps tendon is overly stretched. Then it won’t allow the knee to bend much farther than 90 degrees, sometimes not even that far. Once their range of motion becomes limited like this, their strength just continues to diminish, making the likelihood of regaining adequate range of motion even smaller. So, one problem causes another problem, and so continues this vicious cycle.
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There is Hope!
Although there is no known method of reversing Patella Baja once you have developed the condition, there are ways of treating it, and even better, ways of preventing it from happening in the first place. Promisingly, studies have found that regimented daily stretching and strengthening routines can bring back much of, sometimes even all of, the range of motion. Increased flexibility will continue to improve their strength. And with good strength and flexibility, the person can live an active, normal life.
In order to avoid developing Patella Baja after TKA, take the same steps as you would to rehab it. Patella Baja after TKA usually occurs due to inactivity. By staying consistent in your strength and mobility routines, you will almost surely avoid developing the nasty condition. As with most injuries that result in pain or swelling, post-exercise icing and elevating can go a long way during the rehab process as well.
Range of Motion and Strength
One mistake people with knee problems often make is only working to improve either their range of motion OR their strength. If you only work to improve your range of motion, your quadriceps may remain unable to support you. In this instance your condition will see very little improvement. If you only work on strengthening your quadriceps, they will get stronger, but you may end up with less flexibility. The key is to consistently stretch and strengthen. And, over time, your condition can improve markedly.
If you think there’s a chance you may have this condition, run it by your doctor before attempting to treat it. This is because other types of knee injuries can have similar symptoms but very different forms of treatment.
REFERENCES: https://bonesmart.org/forum/attachments/patella-baja-and-alta-png.63196/ https://www.braceability.com/blogs/info/patella-alta-baja Floren, M., Davis, J., Petersen, M., Laskin, R. (2007). A Mini-Midvastus Capsular Approach with Patellar Displacement Decreases the Prevalence of Patella Baja. The Journal of Arthroplasty, 22. DOI: 10.1016/j.arth.2007.05.008 Anagnostakos, K., Lorbach, O., Kohn, D. (2012). Patella baja after unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 20. DOI: 10.1007/s00167-011-1289-4
Great article Mike! In my time as a PTA I’m guessing I have encountered people with this condition who had no idea they were dealing with it. It sounds like it is a common problem that isn’t talked about enough. This speaks to the importance of BOTH stretching and strengthening when rehabbing, which is vital with all conditions, to avoid muscle imbalance.
Wow! Thanks so much Mike….. My hope is that our X10 patients will continue the targeted activity of stretching and strengthening for months and years following their knee surgery. Thank you for helping us to understand the potential risk and how patients can avoid being faced with Patella Baja.