Patella Alta (High-Riding Kneecap) – Everything You Need to Know

Millions of Americans suffer from knee pain that is severe enough to limit their activities each day.

Usually, it is due to minor ailments, such as low-grade inflammation or scarring from an old injury.

But sometimes, there is a more severe problem with the structure of the knees, which is impairing the flexibility of the joints.

According to Radiopaedia, one of the rarest medical conditions that can lead to this kind of damage is “patella alta.” (1)

But while it doesn’t occur as often as other types of knee problems, it can significantly impair a person’s mobility and permanently affect their ability to walk or bend down if it goes untreated.

Because of this, this article will discuss the most important aspects of the condition, so those who are at risk for developing it will be able to quickly recognize the signs that they need to seek emergency medical attention right away.


What is Patella Alta?

Physiopedia says that patella alta is a condition of the kneecaps, which are called the “patella” in medical terminology.(2) They are supposed to sit against the cartilage that connects the femur and tibia bones together.

This position allows them to undergo a lot of friction, which makes them grow in size. So by the time a person reaches an adult stage of life, they have kneecaps that coordinate with the size of their much larger bones.

This isn’t easy for the body to achieve though, since the patella is smoother than glass. The tissue that lies directly above it can glide over it quite easily.

That means, it takes a significant amount of movement for enough friction to affect it, which is why exercise is so crucial to the development of the kneecaps.

Those who stay sedentary have a much greater risk of problems occurring than those who are more active from a young age.

However, HSS says that if someone develops this condition, and it doesn’t get treated in time, their kneecaps won’t grow the way that they are supposed to.(3)

That is because patella alta translates to “high kneecap.” Instead of the kneecaps being situated in the connection between the femur and the tibia, they get stuck up higher on the leg.

And this makes mobility very difficult because the tendons from the joint between the femur and tibia are still attached to them.

Each time that a person attempts to bend their knees, the tendons get over stretched, which is extremely painful. Usually, this condition occurs simultaneously in both knees, but it is possible to have it happen in just one knee at a time too.


What are the Causes of This Condition?

According to Healthh, there are two basic causes of patella alta.(4) It can happen in those who are born with some type of genetic deformities, which makes the kneecaps not stay in their normal position.

This condition isn’t usually noticeable until an infant is old enough to walk though, especially in babies of a healthy weight.

The fat in their legs thickly covers the knee area, so it isn’t predominant. But as they grow, parents can see that their knees don’t bend as they should.

Crawling, walking, or scooting on the floor is more difficult for them in comparison to other babies. However, parents who have previously had other children with genetic deformities are more apt to recognize the problem sooner.

The second cause of patella alta is some type of trauma to the knees. If they are both affected simultaneously, then both knees are more likely to have the condition.

This is common in head-on collisions in a car crash, which crumples the front of the car into a person’s lower body. It can also happen when a person falls down on their knees too hard while playing sports or any other high-impact activity.

If just one knee is impacted by the injury, then it will be the only knee that develops patella alta though.

An example of this is a baseball player running and sliding into the home plate. The action would take place so quickly that the tendons around the knee wouldn’t be relaxed enough to stretch and shrink back with the force.

That is because baseball players do some warm-ups before they play in the game, but they spend a significant amount of time being inactive during the long waiting periods in the field. And the starting and stopping makes them more prone to injuries.

The same goes for basketball and football players.


What are the Most Common Symptoms?

Pain in the knee region is the first sign that there is something wrong.

Small children who have the condition will often cry if they are laid down on their stomachs because this will put pressure on the front of their legs.

And they will avoid any of the movements that are required for mobility. If the condition goes untreated until the child is old enough to talk, then they will be able to point to the source of the problem.

However, if too much time passes by, their kneecaps will be severely underdeveloped because they didn’t receive the proper amount of friction to grow in size.

Orthoinfo says that the main cause of the pain in patella alta is the over extension of the tendons that hold the kneecaps in place.(5)

Since the tendons are not as flexible as muscle tissue is, the longer that they have to try to reach past their normal grasping point, and the more stressed that they will become.

Sometimes, this condition will cause them to completely tear, and this poses further medical problems.

Torn or damaged tendons can be identified by pain and swelling in the knee region. But it will be much higher up on the leg though.

Patella alta is sometimes called a “high-riding” kneecap condition because the kneecap is pushed so far above where it is supposed to be. If it is pushed below, then this refers to a different kind of medical condition called “patella baja.”

Between the over-extended tendons and the pain, mobility is extremely difficult.

To get around, those who have this condition have to keep their legs almost entirely straight, and this can be seen in the way that they walk in a straight-legged fashion, swinging their legs from side-to-side instead of forwards and backwards.

A wheelchair will do them little good unless it is designed to allow their legs to remain straight.


What Treatment Options are Available?

The National Library of Medicine says that treating patella alta is a painstaking process for those who prefer noninvasive methods.(6)

The tendon has to be trained to pull the kneecap back into place through either physical therapy or taping. Or sometimes, according to the Mayo Clinic, a combination of the two is needed.(7)

Physical therapy reduces the rigidity of the tendons, so they become flexible enough to let the kneecap drop down some. And taping prevents the kneecap from inching its way back up on the leg again.

The taping method has to happen gradually though, and it isn’t a comfortable procedure to undergo, since it limits mobility even further. While the special tape is in place, a person cannot attempt to crawl or bend their knees because it is can cause serious damage to the muscles, tendons, and kneecaps.

Instead of waiting months for the process of taping and physical therapy to work, WebMD says that some people may prefer to undergo surgery.(8)

The tendons have to be cut to free the kneecap, so it can be set into the position it is supposed to be in. Then, they are reattached.

But while this option is faster, it also has more risks to it. The tendons are more likely to tear afterward. And blood clots can develop because a person has to remain in bed for so long. There is also a lot of pain to deal with until the area heals.


What Should a Person do if They Think That They Might Have This Condition?

Because of the way that this condition reduces mobility, it is crucial that anyone who might have it seek medical treatment from a licensed physician who is trained in knee problems right away.

The longer that patella alta goes untreated, the worse that it will become. This isn’t a condition that will get better over time, such as the way that more milder kneecap problems do.

After seeing a doctor, a person should be sure to follow their instructions carefully.

There will more than likely be a list of exercises to do on a daily basis, medications to take, and physical therapy sessions to attend. If all of these tasks are performed, a person’s chance of recovery is greatly improved.


When is Seeing a Doctor for Patella Alta Necessary?

According to HX Benefit, there is no other way to treat patella alta besides seeing a licensed physician.(9)

Most herbal remedies and other types of natural medicine are not effective for this type of medical condition.

However, there are some that can be applied topically to the skin to reduce pain, swelling, and inflammation of the area, such as capsicum and menthol cream. They only work for a short time though. And they do nothing to correct the position of the high-riding patella.

Besides this, the position of the kneecap has to be monitored through x-rays during all of the treatment procedures to ensure that it gets put back in place correctly.

And it takes a person with a trained eye to be able to see any other problems that are developing. So those who try to attempt to do this themselves could cause more harm than good.

In some rare cases, patella alta could develop suddenly. If this happens, it is usually because the tendons have snapped.

Sometimes, it happens from sudden force too. It is crucial that a person gets to an emergency room as quickly as possible for treatment, especially since there could be other injuries that have occurred to the legs beside the awkward position of the kneecaps.


In conclusion, while the occurrence of patella alta is rare, it can happen to anyone of any age.

Sometimes, babies are born with it because of a medical deformity that was caused by genetics. In these cases, parents who intend to have other children should be sure to watch carefully for any signs of the condition in their babies.

But since the University of Maryland says that the condition can also occur quite suddenly, adults who are at risk for high-impact injuries to the knees should be sure to take the following precautionary steps if they believe that they may have developed patella alta;(10)

  • While sitting in a comfortable position that keeps the legs straight, feel for the position of the kneecap. It should be located at the joint between the femur and tibia bones.
  • If it is not in this correct position, gently feel above the joint to check for the location of the kneecap. Usually, high-riding kneecaps are raised up a few inches above the joint.
  • Don’t attempt to push the kneecap into place if patella alta is present. This could cause further injuries to the kneecap and the tendons that are attached to it.
  • Ask a family member or friend to drive you to the local emergency room. Driving with knees that can’t bend properly could lead to a vehicle accident because it makes it impossible to press on the pedals or sit correctly in a position to see the traffic.
  • After seeking medical treatment, follow the doctor’s orders closely. This will ensure that the condition successfully improves.