Patellar Subluxation Exercises
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Patellar tracking disorder, sometimes written as patella tracking disorder, can also be called patellar maltracking. It is a condition that affects the alignment and movement of the knee cap when your knee bends and straightens. The knee cap, or patellar, is a fairly flat, and roughly triangular bone that sits at the front of the knee within the tendon of the quadriceps muscle. It is held in place by ligaments attaching it to the femur and tibia bones. The underside of the patella has two facets with a complementary shaped ridge to fit with the shape of the end of the femur bone. Therefore, when the knee bends the patella sits within the groove of the femur, called the trochlear groove.
Patella tracking disorder occurs when this mechanism doesn’t work effectively and the patellar is not held effectively in the correct and efficient alignment. In the majority of cases the patellar will move excessively towards the outside of the knee, but is is possible, though less common for the patella to move excessively inwards. This maltracking of the patellar can be caused by:
With a patellar tracking disorder, you will feel pain at the front of your knee and there may be swelling. Usually, pain is felt under the patellar at the front of the knee. Pain worsens with more activity, especially impact activities such as running and jumping, bending the knee such as squatting or walking downstairs, and twists of the knee such as changes of direction. This may be accompanied by a feeling of instability of the knee, as though it might buckle with these movements. In some more severe cases, there will be a grinding, catching or slipping sensation at the knee. Sometimes swelling might be present, this is more likely after a sudden onset of symptoms, such as after trauma.
Assessment of a patellar tracking disorder should be done by an experienced physical therapist or sports doctor. They will assess the movement and function of your knee, as well as the strength and tension of the surrounding muscles. They will look at how you move when walking, squatting or descending stairs and feel the movement of the knee cap when your knee is bent and straight. There is no specific test that can be done to diagnose this disorder but rather it is the conclusion from the collection information gathered during your assessment.
Often further information can be gathered from an x-ray or MRI scan. This will be looking for signs of damage to the underside of the patellar and the surrounding ligaments. If the patellar is tracking inefficiently, the cartilage on its underside can become damaged. This can cause worse pain and swelling, and will increase the risk of earlier development of arthritis in the patellofemoral joint.
Treatment for patellar tracking disorder involves taking a break or at least reducing the aggravating activities if there is persistent pain. Then it is necessary to address all of the contributing factors for long-term improvement. This may include massage, stretching and lengthening tight muscles, strengthening weak muscles and improving the biomechanics of the leg through physical therapy. Foot and hip strength and alignment will also be addressed if this is appropriate and orthotics may be prescribed if the therapist thinks that the foot posture and control is contributing to the problem. If appropriate advice on weight loss may be given as this can significantly increase the risk of patellar tracking disorders and patella dislocation.
Taping the knee can help to guide the movement of the patella and restrict its movement into positions that might cause pain and/or damage. Tape can be applied using either rigid or elasticated tape depending on the level of support needed. The most effective taping technique is the McConnell technique, which uses three strips of rigid tape placed with different angles and directions of tension to support the patellar.
An alternative to taping is to use a knee brace. While this offers less specific support than tape, it can be a good option for those who have allergies to tape, or those that need the support longer term. You should look for a brace with patellar supports, such as this BioSkin Brace. This has an adjustable lateral support to prevent the outwards movement of the patellar.
Rehabilitation for patella tracking disorder consists of exercises to relax and lengthen the tight muscles, and strengthen and improve the engagement of weaker muscles, that impact the alignment of the patellar. You can read more about exercises for patellar tracking disorder in our related article.
In only the most severe cases of repetitive dislocation, or in elite athletes might surgery be considered. Surgery can involve a release of tight lateral muscles and tendons such as the vastus lateralis, and/or a medial muscle and tendon relocation, which can be done by moving the boney attachment to a more central point. In either case, it is significant trauma to the knee that will need a long period of recovery and rehabilitation after. And should only be considered when conservative options have been exhausted.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.