Patellar Tracking Disorder: A Complete and Updated Guide

Introduction

Patellar tracking disorder—often referred to as patellar maltracking—occurs when the kneecap (patella) does not glide in its normal path within the trochlear groove of the thigh bone during knee movement.
In a properly functioning knee, the patella stays centred and moves smoothly as the leg bends and straightens. When this alignment is disrupted, the kneecap may drift outward, tilt, or partially slip out of place.

This condition is among the most common causes of pain in the front of the knee, especially among teenagers, young adults, and active individuals. Women experience it more often due to naturally wider hips and a larger Q-angle. Athletes such as runners, dancers, cyclists, and jumpers are also more vulnerable because of repetitive knee stress.

Common activities that aggravate symptoms include:

Going up or down stairs
Squatting or kneeling
Sitting for long periods (“theatre sign”)
Transitioning from sitting to standing

If left untreated, maltracking can contribute to cartilage softening (chondromalacia patellae), recurrent patellar instability, and eventually patellofemoral joint degeneration.
The encouraging news: most cases respond extremely well to structured physiotherapy, because the primary cause is muscular imbalance rather than structural deformity.

Knee Anatomy and How the Patella Functions

The knee joint is formed by three bones:

Femur (thigh bone) – houses the trochlear groove where the patella glides.
Tibia (shin bone) – supports the femoral condyles.
Patella (kneecap) – a floating bone embedded within the quadriceps tendon.

Important soft-tissue components include:

Quadriceps tendon → patella → patellar tendon → tibial tubercle
Medial & lateral patellar retinacula
MPFL (medial patellofemoral ligament) – prevents excessive lateral patellar movement
VMO (vastus medialis obliquus) and VL (vastus lateralis) – regulate kneecap alignment
Iliotibial band (ITB) – contributes to lateral pull

The patella increases the quadriceps' efficiency, allowing it to extend the knee with greater force.

How the Patella Moves

During knee motion:

Full extension (0°): Patella rests above the trochlear groove
20–30° flexion: Patella engages in the groove
Deep flexion: Patella moves downward with a slight natural outward glide

Activities like stair climbing or squatting increase pressure on the patellofemoral joint—often where pain becomes noticeable.

What Is Normal Patellar Tracking?

Normal tracking means:

The patella glides centrally in the groove
Movement is smooth and controlled
Minimal lateral or medial deviation occurs
No sudden tilting or “jumping” of the kneecap

What Is Patellar Tracking Disorder?

Patellar tracking disorder develops when the kneecap shifts excessively toward the outer side or tilts outwards during movement. This misalignment may be subtle or significant enough to cause partial dislocation.

Potential outcomes include:

Uneven wear on the knee cartilage
Pain around or behind the patella
A sense of knee weakness or instability
Increased risk of patellofemoral osteoarthritis

Causes and Risk Factors

1. Structural Factors

A shallow or flat trochlear groove
Patella alta (high-riding patella)
Enlarged Q-angle (common in women)
Lateralised tibial tubercle position

2. Muscular and Neuromuscular Contributors

Weak VMO
Tight or overactive vastus lateralis
Weak hip abductors/external rotators
Poor core stability leading to dynamic knee valgus

3. Other Risk Factors

Joint hypermobility
History of patellar dislocation
Overtraining or high-impact activities

Clinical Assessment

Physical Examination Tests

Patellar glide test: checks medial/lateral mobility
Patellar tilt test: identifies lateral retinaculum tightness
J-sign: sudden lateral jump during extension
Apprehension test: evaluates instability
Ober test: assesses ITB tightness
Single-leg squat: reveals valgus collapse

Diagnostic Imaging

Sunrise/Merchant X-ray views
MRI to examine cartilage and MPFL
CT scan to measure TT–TG distance

Physiotherapy Treatment

Physiotherapy remains the most effective, first-line treatment for patellar maltracking.

Phase 1: Pain Relief and Inflammation Management

Temporary activity modification
Ice and NSAIDs
McConnell taping or kinesiology taping
Quadriceps isometric exercises

Phase 2: Correct VMO Recruitment and Improve Flexibility

Terminal knee extensions
Quad sets with hip adduction
Stretching: ITB, hamstrings, quadriceps, calves

Phase 3: Strengthen Hips and Core

Clamshells
Side-lying hip abduction
Monster walks with resistance bands
Single-leg bridge progressions

Phase 4: Functional and Sport-Specific Training

Eccentric quadriceps control
Lunges and step-downs
Squat retraining
Running and jumping technique correction

Best Evidence-Based Exercises

Terminal Knee Extension (TKE) with resistance band
Controlled step-downs (10–15 cm step)
Spanish squat for isometric quadriceps activation
Clamshells or side-lying hip abduction
Single-leg Romanian deadlift
Wall slides with a ball squeeze
Forward and reverse lunges with proper knee tracking

Progression should move from:
Isometric → Concentric → Eccentric → Plyometric

Taping and Bracing Options

McConnell Taping

Provides immediate realignment
Reduces pain
Encourages VMO activation

Patellar-Stabilizing Braces

Common examples:

DonJoy Lateral J
Bauerfeind GenuTrain P3

These braces help maintain medial patella positioning—ideal during sports or early rehab.

Kinesiology Tape

Enhances neuromuscular feedback
More flexible and comfortable than rigid taping

Note: Braces and tape support recovery but are not long-term solutions.

Frequently Asked Questions

1. Can patellar tracking disorder improve without treatment?

Mild cases may improve with rest and basic strengthening, but persistent symptoms typically require targeted physiotherapy to avoid long-term knee damage.

2. Is surgery commonly needed?

Only in a small number of cases, usually those with significant anatomical abnormalities, recurrent dislocations, or failure of conservative rehabilitation.

3. Will a brace fix the problem permanently?

No. Braces help reduce symptoms but cannot correct muscle imbalances or movement patterns.

4. Why does it hurt more when going downstairs?

Descending stairs increases patellofemoral joint forces, placing higher stress on a maltracking patella.

5. Can I return to running?

Yes—many people return successfully after improving hip strength, core stability, and movement mechanics.

Conclusion

Patellar tracking disorder is a leading cause of anterior knee pain, particularly in active young adults and women. Fortunately, most cases respond extremely well to a structured physiotherapy program focusing on:

VMO strengthening
Hip and core stability
Correct knee alignment
Improved flexibility of tight tissues

With consistent rehabilitation, many individuals experience significant improvement within 6–12 weeks, preventing complications such as cartilage damage and patellofemoral arthritis.

Early evaluation and tailored treatment ensure a faster, safer return to daily activities and sports.

This article is intended for informational purposes only and does not replace professional medical advice.

Patellar Tracking Disorder: A Comprehensive Guide