Patellar maltracking is a condition that might exist right under your nose, yet go unnoticed for significant lengths of time. “When the knee bends and extends, the patella or kneecap should glide along the track of the femur. However, when it pops out of its grove, it is called patellar maltracking,” says Dr John Ebenezar, consulting orthopedic surgeon and spine surgeon, Parimala Health, Bangalore. “It is a disturbing condition that affects people’s mobility, activity, and confidence as they find it difficult to perform everyday tasks.” Identifying the condition and its causes are vital to treating each individual case, say experts.
“Patellar maltracking is a disturbing condition. It affects people’s mobility, activity, and confidence as they find it difficult to perform everyday tasks,” says Dr Ebenezar.
Causes of patellar maltracking
Patellar maltracking can arise from many factors. Muscular imbalance, where certain muscle groups overpower others, is one of the common causes. The misalignment can also stem from overuse, injury or biomechanical irregularities, making it prevalent in athletes and active individuals.
“If the muscle on the outer side of the knee is tight and contracted while there is looseness or weakness on the inner side, the patella can go out of the groove,” explains Dr Ebenezar, a Padma Shri recipient and Dr BC Roy award winner. “The ligaments and muscles on the inner and outer side of the knee should be balanced.”
Ligament issues, especially in the medial patellofemoral ligament (MPFL), lead to instability, allowing the kneecap to veer away from the groove. “The femur trochlea is the track in which the patella glides, if there is an abnormal growth or defect in the grove, the patella can come out,” adds Dr Ebenezar.
Besides, trauma, whether caused by sudden injury or repetitive stress, may initiate maltracking.
Symptoms of patellar maltracking
Patellar maltracking has many symptoms that point to disturbances to the delicate balance within the knee joint. These include:
Discomfort: Discomfort, which may be accompanied by swelling. These reflect the joint’s response to misalignment-induced stress.
Pain: Pain in the anterior part of the knee while doing certain activities.
Audible signs: Sounds such as clicks or pops during movement can be a sign of abnormal tracking.
Instability: One may find that the kneecap is out of place when one tries to do everyday activities like walking. “They may suddenly find it difficult or uncomfortable to squat, walk, run, or climb the stairs. All these are the complaints of patella maltracking — it is not just pain,” says Dr Ebenezar.
Altered movement patterns: Patella maltracking often unveils itself through subtle shifts in gait, where the affected knee may display altered movement patterns. “People with this condition will find it difficult to climb down the stairs. The patella may be pushed out during other activities, including squatting, jumping, walking, sitting, bending, getting up and walking, and the person may suffer for a long time,” says Dr Ebenezar.
Recognizing these symptoms early is crucial for prompt intervention and tailored rehabilitation. “Patella maltracking is a chronic condition affecting one for a long time; besides, people don’t seek treatment immediately. Anything lasting beyond three to four weeks is called a chronic condition,” explains Dr Ebenezar. “People may not always notice the initial episode — and even if they do, they do not opt for proper treatment immediately.”
Tackling patella maltracking
“In initial stages, conservative methods such as medicines, painkillers, physiotherapy, exercises, taping, knee braces and orthotic shoe modifications are used to treat patella maltracking. By doing these, the patella may stay inside and not pop out,” says Dr Ebenezar. Physiotherapy takes center stage, focusing on correcting muscle imbalances and enhancing joint stability through targeted exercises.
“If it does not respond to any of the conservative treatment methods, we opt for surgery. Here, we tighten the inner side of the joint, release the lateral contracted structure and transfer the tibial tubercle down and inwards. Keyhole surgery or open surgery can be performed in such instances. However, most cases can be managed without surgery,” says Dr Ebenezar.
Patient education on biomechanics and movement patterns, coupled with lifestyle modifications, prove instrumental in long-term management.
Takeaways
- Patellar maltracking is when the patella, or kneecap, loses its intended track along the femoral groove, causing discomfort and pain.
- It can be caused by muscular imbalances, deformity in the bone structure or trauma from overuse or sudden injury.
- Treatment approaches for patella maltracking should be holistic, combining physical therapy to correct muscle imbalances, targeted exercises to strengthen supportive structures, and in severe cases, surgical interventions.
