About Patellar Tracking Disorder

Patella is the medical term for your kneecap. Patellar tracking disorder (or patellar maltracking) describes movement of your kneecap that isn’t aligned, like your kneecap moving sideways. It can usually be relieved with exercises and physical therapy.

The kneecap is a separate bone that’s attached to your thigh bone (femur) at the top and your big shin bone (tibia) by powerful tendons and ligaments. It is a type of bone that forms within a tendon to give a mechanical advantage for the knee.

When it’s working properly, the kneecap glides in a groove or cutaway that’s near the end of your thighbone called the trochlear groove.

Injuries from sports, overuse, or trauma can cause the patella to move slightly off and not track properly in the trochlear groove. In most cases, the kneecap shifts to the outside of the leg, but it can also move towards the inside.

Here’s what you need to know about patellar tracking disorder and keeping your knees healthy.

Symptoms of patellar tracking disorder include:

• pain, and possibly swelling, in the front of the knee, that increases when you squat, jump, kneel, run, or walk downstairs
• a popping, grinding, slipping, or catching feeling when you bend your knee
• a feeling that your knee is buckling under you

Pain varies depending on the severity of the disorder.

An example of a severe case of a tracking disorder is a dislocation. If the patella is completely dislocated, you’ll usually feel a lot of pain. Your leg may appear bent or out of shape, and you may not be able to bend or straighten your knee or walk.

Patellar tracking disorder is more common in women and in athletes of both sexes. It can also affect older people, because of arthritis in the knee joint.

Generally, patellar tracking disorder comes from high stress on the knee, especially the twisting motions that occur in many sports.

Muscle weakness, poor tone, and structural abnormalities can cause you to be more susceptible to patellar tracking disorder. Risks include:

• weak thigh muscles (quadriceps), although there’s some controversy about this
• imbalance in strength between hamstrings and quadriceps (called the H:Q ratio), but again, not all researchers agree
• tendons, muscles, and ligaments that are too tight or too loose in your leg
• being overweight
• turned-in knees (knock-knees), known as valgus
• flat feet (pronation)
• high-arched foot (supination)
• high Q-angle (the angle between the thigh and shin bone when your knee is extended), although one dated study suggests otherwise
• structural problems in your knees or leg alignment, such as a shallow trochlear groove

Although patellar tracking disorder is a common diagnosis for knee pain, there’s controversy over whether it’s the root cause of many cases of knee pain.

Diagnosis of patellar tracking disorder can be difficult, because it’s part of a broad range of conditions that can affect the knee, with fairly similar symptoms.

Unless the patella is severely dislocated, there may be little visual evidence of the problem.

To determine if you have a patellar tracking disorder your doctor will do a physical examination, flexing and putting the knee in various positions. They may observe you walk, squat, rise from a seated position, and sit down.

They may order X-rays or MRI scans to help see if there’s any other damage that may be causing your pain.

Some doctors or therapists may use an instrument to measure the angle between your femur and tibia when extended (called the quadriceps-, or Q-angle). But at least one dated study has shown that the normal Q-angle varies greatly for people, and there’s no clear correlation of Q-angle for people with pain symptoms and those without.

Treatments for patellar tracking disorder include home remedies, professional physical therapy, and surgery.

For some people, home remedies are enough to relieve the pain of patellar tracking disorder. Home remedies include:

• rest or reduced activity level
• stretching and strengthening exercises
• flexible knee braces
• taping
• proper footwear
• weight loss
• over-the counter pain relievers (ibuprofen, acetaminophen, aspirin), if you tolerate them well

The RICE method (rest, ice, compression, elevation) is a good place to start your home treatments. Rest completely after a painful episode, and only return to activity as you improve. Pull back if you start to feel pain, or you may aggravate things more.

Purchase flexible knee braces online.

Knee taping

Kinesiology (kinesio) tape is a thin adhesive tape that’s rigid in one direction and flexible in the other.

The tape is widely used by sports trainers, and many athletes report significant pain relief from use of the tape. But studies haven’t shown conclusive evidence of a real improvement. Larger, high-quality studies of kinesio tape for musculoskeletal injuries are needed.

The mechanism of the tape isn’t certain. At least one manufacturer claims that the tape lessens pain and improves healing by creating a space between the skin and the tissue below to allow for improved blood and lymph flow.

Another knee taping method thought to work similarly is known as the McConnell taping technique, which was introduced in the 1980s by Jenny McConnell, an Australian physical therapist.

One 2013 study of 20 subjects found that both the McConnell taping and kinesio taping techniques may be effective in reducing knee pain while stair climbing.

Purchase kinesiology tape online.

Physical therapy

A licensed physical therapist may be able to provide pain relief and improvement for your patellar tracking disorder.

A physical therapist will give you strengthening exercises, concentrating on the quadriceps. This is a group of four separate muscles in your thigh that control knee extension and flexion.

Special attention typically is given to the VMO (vastus medialis obliquus), the part of the quadriceps on the inside of your thigh. The idea is that strengthening the muscles that control the knee will help the kneecap to move properly in the trochlear groove.

You’ll also work on stretching and flexibility. A good therapist can guide you in how much to exert, and when to pull back.

If you don’t feel improvement in a couple of months, something else may be wrong. Other problems may be aggravating the pain. Some common possibilities are:

• hard, uncomfortable shoes
• flat or high-arched feet that aren’t corrected
• weak or tight muscles elsewhere in your body
• overdoing it in your exercise, sports, or daily activity

Surgery

Surgery isn’t usually needed. If your doctor suggests that surgery will relieve the pain, discuss the reasoning fully. Be aware that there’s conflicting evidence about the efficacy of surgery for patellar tracking disorder.

One commonly recommended surgery is to make a cut in the ligament, the lateral retinaculum, that anchors the outer edge of the patella.

Another surgery is repair of the medial patellofemoral ligament (MPFL) that attaches to the inner side of the kneecap, and can keep it from slipping outward.

Both of these can be done with arthroscopic surgery, using a small incision. You may have to stay home for a week or longer after surgery. Complete recovery can take six months to a year.

The keys to prevention are:

• Stretch your legs before and after exercise.
• Work out to build and keep up the strength in the muscles around your knees, thighs, and hips.
• Maintain a healthy weight.

Staying active with patellar tracking disorder

Whether you walk a lot or are an athlete, holding back to avoid over-exertion after an injury may be the hardest advice to follow, but it’s also one thing you can do to get you back to your activity the fastest.

If you’re a runner or athlete, you probably already know that your sport can put a lot of stress on your knees.

Consult with a trainer or physical therapist to help you evaluate how soon to return to your favorite activity, and how to work gradually back to full strength.

Patellar tracking disorder can be painful and keep you from enjoying your favorite sports and recreational activities. Home remedies and physical therapy can usually get you back to them within a few weeks to months.

If you’re not getting good results from physical therapy, consider what other factors might be involved. The knee pain could be due to other things, even something as simple as your footwear.

Surgery is a last resort. Be sure to talk with your doctor and specialist about what’s best for you. Get at least one second opinion before proceeding with surgery.