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. Not that this lack of mobility isn’t bad enough, but it will also usually lead to weak leg muscles, more specifically, weak quadriceps muscles.
This is because with your knee cap sitting so low, the tendon above your knee is constantly being stretched further than it wants to be, just to reach your knee cap. When you bend your leg further and further, it continues to stretch that tendon even more, and eventually it just refuses to stretch any further, 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 something you would attempt in your wildest dreams.
Total Knee Arthroplasty (Knee Replacement) Patients
People who have 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 hugely increased risk of developing Patella Baja. Studies have found that the prevalence of the condition occurs in anywhere from 25-34% of TKA patients, usually starting after a month and progressively worsening for up to 4 years post-surgery.
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I consider myself fairly determined, and when I saw that the number 130 was the end, it was like okay, I'm going to go there. Every day there was progress, and that was what was so heartening. I could see that I was getting stronger and better.
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What often happens is after an individual has a TKA, they go through their usual therapy, then once that is complete after typically 4-8 weeks or whatever it may be, they return to a mostly sedentary lifestyle. The longer they are inactive, the weaker their quadriceps 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 and won’t allow for them to bend their knee 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 their range of motion even smaller. So, one problem worsens the other problem and so continues this vicious cycle.
Knee Manipulation Under Anesthesia Articles
When the recovery stalls around six weeks after knee surgery patients naturally get upset about the whole thing. I regularly hear the words “I wish had had never had this surgery. I’d rather go back to my bone-on-bone self.” And I know this can be fixed.
Help! I'm stuck!Yes, that was me nine weeks post surgery for total knee replacement. I could not get past 100º on my own or 105º with the therapist. For several years I had been going to the gym three or four times a week for yoga, Pilates, stretch and flex, and interval classes, so this degree of motion was not acceptable to me.
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. Since Patella Baja after TKA usually occurs due to inactivity, by staying consistent in your strength and mobility routines will almost surely prevent you from ever 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. 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 will remain unable to support you and your condition will see very little improvement. If you only work on strengthening your quadriceps, they will get stronger, but also less flexible, which will make bending your leg even harder. The key is to consistently stretch and strengthen and over time, your condition can improve drastically.
If you think there’s a chance you may have this condition, run it by your doctor before attempting to treat it 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
The X10 Meta-Blog
We call it a “Meta-Blog” because we step back and give you a broad perspective on all aspects of knee health, surgery and recovery.
In this one-of-a-kind blog we gather together great thinkers, doers, writers related to Knee Surgery, Recovery, Preparation, Care, Success and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. Whether you have a surgery upcoming, in the rear-view mirror, or just want to take care of your knees to avoid surgery, you should find some value here. Executive Editor: PJ Ewing (info@x10therapy.com)
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.