Patella Baja Revisited: Interposition of a Pedunculated Flap of the Hoffa Fat Pad to Treat Adhesions Between the Tibia and Patellar Tendon and Restore the Functional Length of the Patellar Tendon

Adhesions in the deep infrapatellar region may occur as iatrogenic complications (e.g., after bone–patellar tendon–bone grafting), as part of arthrofibrosis or infrapatellar contracture syndrome, or owing to specific diseases such as Osgood-Schlatter disease. Described adhesions may limit the length of the functional portion of the patellar tendon and lead to patella baja with subsequent decreased range of motion and patellofemoral joint overload, with a risk of osteoarthritis development. The patellar tendon length is commonly within normal limits; however, only the free part of the patellar tendon is functionally active. The purpose of this article is to present a quick, simple, and cost-effective technique for the treatment of patella baja due to adhesions in the deep infrapatellar region. This technique consists of the removal of adhesions to free the whole length of the patellar tendon and the interposition of a Hoffa fat pad pedunculated flap between the patellar tendon and tibia to avoid the recurrent formation of adhesions. Only local tissues are used, allowing for the avoidance of donor-site morbidity. The technique restores the functional length of the patellar tendon and thus normalizes patellofemoral kinematics, increases range of motion, alleviates anterior knee pain, and decreases the risk of osteoarthritis development.