Malalignment of the Knee or Patella

Care of the Patellofemoral Joint and Chondromalacia of the Patella

Patellofemoral problems may be due to malalignment, injury, or softening of the patellar cartilage (chrondromalacia patella).

Malalignment

Malalignment may occur in both males and females, but it is more common in females, especially those who are "knock-kneed." The patella tends to tilt to the outside of the knee and may even dislocate (see image below). This may be treated with exercise to strengthen the vastus-medialis-obliques, or VMO muscle, which assists in pulling the patella to the medial side of the knee. Bracing may be used as well as McConnell taping. In some cases, a procedure to release the tight tissue laterally is done (lateral retinacular release) through a very small hole using the arthroscope.

In this X-ray, the patella, "knee cap" is tilting to one side placing all of the pressure and wear on this one area.

In some cases, it is necessary to move the attachment of the patella to the tibia (shin bone) to realign the entire extensor mechanism. Trauma from an injury to the patella, such as a fall on the knee or a dashboard injury, may damage the cartilage on the under surface of the kneecap. Certain exercises such as squats, lunges, quad sets and leg extensions may lead to a more chronic form of chrondromalacia patella.