Shortening the Patellar Tendon

In patella alta associated with an excessively long patellar tendon, it is more logical to shorten the patellar tendon than to distalize the tibial tubercle (TT). We have therefore developed a technique to correct this anomaly. It is particularly indicated in patients who are skeletally immature in which a TT transfer would be contraindicated. However, it must be used with caution. It is not a conventional Z-plasty as it has the advantage of maintaining the integrity of the posterior half of the patellar tendon, limiting the risk of rupture postoperatively. It is often combined with an MPFL reconstruction. Jack Andrish has recently described a similar technique.