Patellar tracking disorder (PTD) is the misalignment of the kneecap (patella) as the knee bends and straightens. The patella normally glides within the trochlear groove at the end of the thigh bone. When the kneecap slips out of this path, typically shifting toward the outside of the leg, it is called patellar maltracking. Fixing this issue requires a comprehensive approach, moving from professional diagnosis to targeted rehabilitation and, in some cases, advanced interventions to restore smooth, pain-free movement.
Defining Patellar Tracking Disorder and Its Causes
Patellar tracking disorder is a common source of pain felt around or under the kneecap. Individuals with this condition often experience a grinding or popping sensation when moving their knee. They may also describe a feeling of the knee buckling or giving way, suggesting instability within the joint.
Muscular imbalances are a frequent contributor, particularly weakness in the inner portion of the quadriceps muscle, the vastus medialis obliquus (VMO), and weakness in the hip abductors and gluteal muscles. Structural issues can also predispose an individual to PTD, such as a shallow trochlear groove or a natural malalignment of the leg bones. Activities that involve repetitive stress or twisting movements, like running or jumping sports, can aggravate these underlying issues and lead to symptoms.
Confirming the Diagnosis
A physician or physical therapist will begin with a thorough physical examination, observing the patient’s gait, assessing muscle strength, and palpating the knee to check the patella’s movement. They may perform specific tests to reproduce the maltracking or pain, which helps differentiate PTD from other sources of knee discomfort.
Imaging studies are often utilized to rule out other potential causes of pain. Standard X-rays can evaluate the position of the patella and the alignment of the leg bones. A Magnetic Resonance Imaging (MRI) scan assesses the condition of soft tissues, such as the articular cartilage beneath the kneecap or stabilizing ligaments like the medial patellofemoral ligament (MPFL). These images help identify anatomical factors or structural damage contributing to improper tracking.
Targeted Non-Surgical Rehabilitation
Fixing PTD involves a structured, non-surgical rehabilitation program, typically guided by a physical therapist. The primary goals of this conservative management are reducing pain, restoring a pain-free range of motion, and improving the strength and endurance of the surrounding musculature. This approach aims to dynamically correct the tracking issue by strengthening the muscles that keep the patella centered in its groove.
Strengthening focuses on the quadriceps, specifically the VMO, which acts as a medial stabilizer to prevent the kneecap from drifting laterally. Exercises like quad sets, where the thigh muscle is tightened with the leg straight, are often introduced first to promote VMO activation without excessive joint stress. As tolerance improves, the program progresses to closed-chain movements, such as shallow mini-squats or wall sits, which engage the quadriceps while keeping the foot fixed on the ground. These exercises are performed with careful attention to knee alignment to ensure the patella tracks correctly.
Strengthening also extends beyond the thigh to the hip and core muscles, which provide the foundation for stable leg movement. Exercises targeting the hip abductors and glutes, such as clamshells and straight-leg raises, are incorporated to improve hip stability and reduce excessive inward rotation of the thigh bone during activity. This comprehensive strengthening helps to stabilize the entire kinetic chain, reducing the forces that push the patella out of alignment.
Flexibility is a necessary component of rehabilitation, as tightness in certain muscle groups can pull the kneecap out of place. Stretching the hamstrings, calf muscles, and the iliotibial band (ITB) helps to restore muscle length and reduce lateral tension on the patella. A well-balanced program ensures that the muscles on both the inside and outside of the knee work harmoniously.
Supportive measures can provide immediate relief and assist the rehabilitation process. Patellar taping, such as the McConnell technique, involves applying specialized tape to the kneecap to shift it into a more medial position. This can alleviate pain during exercise, allowing for more effective strengthening of the VMO. Certain braces or custom orthotics may also be recommended to provide external support or correct foot biomechanics that contribute to the maltracking.
Medical and Surgical Interventions
When a rigorous course of conservative treatment fails to resolve symptoms after an extended period, typically three to six months, or in cases involving severe structural damage, medical and surgical options are considered. Medical interventions are generally supportive, such as the use of non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation during flare-ups. Injections, such as corticosteroids, are sometimes used to reduce inflammation in the joint, but they are not a direct treatment for the tracking problem itself.
Surgical procedures are typically reserved for individuals with chronic instability or significant anatomical abnormalities that cannot be corrected through rehabilitation. These procedures fall into two main categories: soft tissue and bony realignment.
Soft Tissue Procedures
Soft tissue procedures may involve a lateral retinacular release, which cuts the tight tissue on the outside of the knee to reduce the lateral pull on the patella. A more common modern approach is Medial Patellofemoral Ligament (MPFL) reconstruction, which rebuilds the primary ligament that prevents the kneecap from dislocating laterally.
Bony Realignment Procedures
Bony realignment procedures are more complex and are used to address severe structural issues. A Tibial Tubercle Transfer involves moving the bony prominence on the shinbone, where the patellar tendon attaches, to change the angle of the pull on the kneecap. Another procedure, a Trochleoplasty, reshapes the shallow groove in the thigh bone to create a deeper, more defined path for the patella to track within. Surgical intervention requires a significant recovery period, often involving months of post-operative physical therapy to regain full strength and function.
Preventing Recurrence and Long-Term Care
The muscle strength and balance gained during rehabilitation must be maintained through an ongoing, consistent exercise routine. This routine should continue to emphasize the strengthening of the VMO, glutes, and hip stabilizers, even after symptoms have subsided.
Individuals should be mindful of avoiding activities that place excessive, deep stress on the patellofemoral joint, such as deep squats or high-impact running, and should choose appropriate, supportive footwear. Recognizing and addressing early warning signs, such as a slight return of pain or a feeling of stiffness, allows for prompt intervention before a full recurrence develops. Managing PTD is often a continuous process of self-monitoring and maintenance to ensure the kneecap remains on its proper path.