Patella misalignments rarely occurs on its own, usually there is an underlying femur rotational misalignment that shift the tracking groove for the patella to either side, causing the patella not to track smoothly within its designed articulation.

Knee maltracking and the corresponding femur misalignments

ELPS (excessive lateral pressure syndrome); Internal femur rotational misalignments, causes the outer side of the patella to increase the friction and pressure within the patellofemoral groove

LPCS (lateral patellar compression syndrome); External femur rotational misalignments, causes the inner side of the patella to increase the friction and pressure within the patellofemoral groove.

Assessment

The entire Lower extremity biomechanical chain must be evaluated as per the neurological and mechanical influences of the pelvis, hip, and foot.

Clinical evaluation of the knee and patella alignment as well as visualizing the pattern of compensation presence on the lower extremity.

X-ray analyses

Anterior – Posterior (AP) knee view is essential to evaluate the degree of misalignment involved in this deformity.

Lateral x-ray lateral view is important to properly visualize the rotational misalignments of the femur.

Treatment protocol

Specific adjustments to the knee joint

Stretching and strengthening of specific hip and knee muscle groups

Functional taping may be used in the beginning of the treatment

Depending on the level of deformity and chronicity, minimum 6 weeks of care is advisable to resolve this condition.