What is Patellar Maltracking: Causes, Symptoms, Treatment, Recovery

The patella which is most commonly known as the kneecap is one of the most important weightbearing joints of the lower extremity.¹ Patella or kneecap plays a pivotal role in the way how the knee functions and how it bends along with other motions which require the use of the lower extremities. Since the Patella is one of the busiest bones in the body it becomes vulnerable to injuries, particularly dislocations and patellar maltracking where the patella moves out of its groove resulting in damage to the cartilage surrounding it and pain. Patellar maltracking is quite common in athletes and people who are extremely physically active. These injuries are seen more in people who play high impact sports like football and rugby.

Among the various injuries that can happen to the patella, Patellar maltracking is one such injury. This injury is caused more due to imbalance with the muscles.² Patella Maltracking is an imbalance problem. The muscles in the upper thigh which are the vastus lateralis and the vastus medialis situated on the inside and the outside respectively pull the Patella in different directions resulting in the Patella to move slightly out of position or become imbalanced. Under normal circumstances, the patella should run smoothly between the two sides of the femur, but with Patellar Maltracking, the patella moves out from its normal position and moves to its sides and starts to rub against the femur which is what causes severe pain and discomfort with any motion of the knee. Thus it can be said that Patellar maltracking is more of a problem arising out of muscle imbalance with one muscle being tighter than the other.

As stated above, Patellar maltracking is mostly caused by muscle imbalance between the two muscles that are attached to the patella and when they start pulling the patella in opposite directions.³ Another cause of Patellar Maltracking is a misshapen patella which can be caused due to an injury or direct trauma to the kneecap or patella or due to a surgical procedure done around the patellar region. Patellar Maltracking can also be caused due to damage to the cartilage and due to overuse which is common in athletes especially people involved in sports like running, jumping, and impact sports like football and rugby. In some cases, it has been noted that Patellar Maltracking runs in the family but such cases are few and far between.

The most prominent symptom of Patellar Maltracking is a visible deformity of the kneecap, like being out of shape or not being in the center where it usually is under normal circumstances.

Another symptom of Patellar Maltracking is pain with any type of movement of the knee which worsens as the time goes on. Apart from this an individual with Patellar Maltracking will have difficulty negotiating stairs, either going up or coming down. Standing up from a sitting position will also be difficult in cases of Patellar Maltracking. An individual with Patellar Maltracking will find it extremely difficult to squat. Some of the other symptoms of Patellar Maltracking are popping and grinding of the knee, catching of the kneecap with bending or straightening the leg. In some cases, Patellar Maltracking can also cause the knees to give away resulting in falls.

In order to diagnose Patellar Maltracking, initially a history will be taken of the patient as to when and how the symptoms started and whether there is any history of any injury to the patellar area. The next step towards diagnosing Patellar Maltracking is to conduct a physical examination of the affected area. The physician will palpate the kneecap looking for any areas of tenderness.

Physician will also try to move the leg to see whether there is any worsening pain felt. Generally, a misshapen patella directly points towards a Patellar Maltracking but it can also be a patellar dislocation which needs to be ruled out. This is done by way of radiographic studies in the form of x-rays, MRI or CT scans which will clearly show that the patella is out of its normal groove and thus confirms the diagnosis of Patellar Maltracking.

The treatment of Patellar Maltracking is two fold. One is to reduce pain and second is to strengthen the muscles that attach to the kneecap or patella so that it does not move out of its groove. In case if the pain is not much and the kneecap has not dislocated then few home treatments can usually do the trick and the patient can get rid of Patellar Maltracking. These treatments are:

• Staying away or abstaining from activities that may aggravate the condition like squatting, kneeling, running, and jumping
• Yet another effective treatment for Patellar Maltracking is icing the knee before and after doing any sort of activity for 15-20 minutes alternating it with heat but it is important to make sure that both ice and heat are not applied simultaneously as this may lead to development of blisters.
• Use of over the counter pain medication or an NSAIDs in the form of ibuprofen or Tylenol to reduce pain and inflammation associated with Patellar Maltracking.

Once the pain and swelling associated with patellar maltracking comes down to a tolerable level and you are able to move the leg without much discomfort then the patient can begin exercises to strengthen the muscles. For this, the patient will be referred to a physical therapist who will formulate an exercise regimen best suited to deal with the problem of patellar maltracking. The aim will be to start off slowly with just a couple of exercises and then more exercises may be added.

Another treatment option for Patellar Maltracking is to tape the knee. This may be done with McConnell taping to hold the knee in place. The patient may be put in a knee brace for a few weeks until the muscles strengthen so that the knee does not move out of position causing recurrent Patellar Maltracking

Certain type of orthotics may also be used to try to prevent Patellar Maltracking.

In most of the cases of Patellar Maltracking, surgery is not recommended. It is only required in cases of patellar dislocations where conservative treatments are not effective.

In majority of cases, people with Patellar Maltracking can return back to normal activities with the above mentioned treatment within a span of four to six weeks provided they adhere to the recommendations given by the physician and diligently do the exercises recommended by the physical therapist in order to prevent recurrent episodes of Patellar Maltracking.

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