Knee osteotomies realign the knee in an attempt to better distribute forces
across the knee. The anatomic and physiologic function of the extensor mec
hanism, which includes the quadriceps tendon, patella, and patella ligament
, may be altered during this procedure. An understanding of these changes i
s important especially when additional surgery becomes necessary, such as a
conversion to a total knee arthroplasty. The current authors discuss patel
la mechanics and changes in the patella associated with osteotomies about t
he knee and the influence on normal patella biomechanics. Although patella
changes are uncommon after a distal femoral osteotomy, poor total knee arth
roplasty outcomes after a high tibial osteotomy attributable to patella alt
erations exist. Surgical technique during the primary high tibial osteotomy
and the conversion to the total knee arthroplasty can reliably improve the
final outcome. Rigid internal fixation with early knee mobilization after
high tibial osteotomy reduces the incidence of patella baja and improves to
tal knee arthroplasty outcome after a high tibial osteotomy, whereas while
patella changes after a distal femoral osteotomy are minimal and largely ig
nored.