Maltracking of the Patella

The patella generally does a great job of protecting our knee, but, sometimes, it becomes the thing it swore to destroy: a cause of pain in the joint.
In this video, we'll draw out the way this can happen, looking at what mal-tracking is, why it can happen and how to (potentially) fix it.
Download your own patellar picture here: tinyurl.com/52...
0:00 Intro
0:51 The quadriceps
1:42 Why does maltracking happen?
2:34 How can we stop maltracking?
#maltracking #patella #anatomy

[@magpie1492]

I was born with this problem in both knees. I always thought that I was knock kneed! Knee pain all through my childhood, finally identified in my early 20s. My left patella was 30 degrees out and my right 25. I had my patella tendon realigned on my left, a very painful operation. I didn't have my right corrected and as I have got older my patella pain has increased. Recent MRI shows abnormal wear on my femoral condyles from years of diagonal movement. Interesting video, thanks.

[@magpie1492]

That's the point, there is no fix. This is my normal anatomy. The damage done to my uncorrected knee means that I will require a knee replacement at some point when the pain becomes too much. In the meantime I work on my quads, glutes and hamstrings in an effort to stabilise my knee and reduce pain.

[@jackhargreaves1911]

A great explanation. I’ve had three lateral releases done in my life, and only now do I know why.

[@NextPiece_]

Thank u, I understood this very well

[@lorraineattard1339]

I think you're amazing in every way I just recently found out that i have a patella mal tracking and also a cyst on my knee 😔 My doctor said I was born with the patella mal tracking

[@Anartomy]

Hi Lorraine, thanks for your kind message, but I'm really sorry to hear about your knee difficulties. I hope they're not causing you too much discomfort.

[@lorraineattard1339]

@@Anartomy you're very welcome ☺️ I have a little discomfort and it restricts me in some activities that I use to do I have been driving manual for 15 years ever since I got my licence but I have to change to automatic 😔

[@ninnab8271]

Thank you for the informative video! I have a grinding pain on the outside of the knee/patella (and a tingling sensation around the rest of the patella) after a strech of the quadriceps femoris. I guess I pulled the patella out of optimal position. Do you have any suggestions about how to correct this?

[@Anartomy]

Hi Ninna, I'm sorry to hear about your knee injury. I'm afraid that, as a non-clinician, I wouldn't be able to offer any medical advice. Whilst it could be a patellar issue, I'd recommend speaking to a primary care provider to get a definitive diagnosis/treatment plan. Sorry I can''t be more help!

[@riccardobonfirraro6479]

When i squat, on my way down, my patella does a little click, I believe it gets briefly out of tracks to get back into place right away. Obviously the misalignment is really slight and I can still perform the movement but the sensation of discomfort and instability is really strong. Could my supposition be correct?

[@Anartomy]

Hi Riccardo, I'm so sorry for the late reply! Whilst I don't have the clinical training to offer medical advice, what you've described certainly sounds like it could be patellar maltracking. If the pain/instability is limiting your movements, I'd definitely recommend speaking to a physiotherapist or your primary health care provider.

[@christopherhugh-jones3673]

Hi, good video thanks. I have a complex maltracking syndrome where I feel the patella shift out of its central groove, and then, when I manually manipulate the patella back into its central alignment, there is quite a loud clicking noise. Any ideas? Thanks!

[@Anartomy]

Hi Christopher, sorry for the late reply! So, to me, it sounds like what you're describing is a patellar subluxation (a partial dislocation of the bone). That said, I'm not a clinician, so I'd recommend speaking to a healthcare professional for a proper diagnosis/treatment options!

[@christopherhugh-jones3673]

@@Anartomy thanks! It happens frequently, several times a day, not painful etc. Nonone seems to know but will investigate. Thanks, helpful!

[@mainuser98]

I have patella tracking on the left knee for 3 years now. I feel my knee gets tight and then i have to bend it to release tension. My knee snaps really loud then. Or when i walk sometimes it keeps snapping. I tried to strengthen the vmo muscle but no help, any idea? Its been 3 years 😢

[@Soccasteve]

I feel you, I’m in the same boat. Been rehabbing and laying off leg training for 7 months now. Been doing a lot of different hip/knee rehab exercises and progress seems to be very slow. Still unable to properly train legs. I think my issue is actually related to a tight hip so I’ve been addressing that but in the process of improving my hip mobility I tweaked my groin lol. Always something. So that’s been giving be issues now too.

[@violetgodwin677]

Have you seen anyone who’s patella maltracking resolve and the patella starts tracking up and down instead of side to side?

[@Anartomy]

Hi Violet, I'm afraid I trained/work as an anatomist, so I don't do any direct work with patients! As I understand it, exercises to strengthen the vastus medialis can help resolve some lateral maltracking issues, leading to normal (up-and-down) tracking. However, I'd recommend speaking to a health care professional if you're like more details about potential treatments or interventions. I hope this helps!

[@violetgodwin677]

@@Anartomy thank you for the reply!

[@hamidman6974]

After falling down while playing football, I think I have similar to this problem, but opposite. Meaning, when extending my knee, my patella is touching something which cracks/clicks - but If I move the patella laterally with my hand this doesn't happen anymore. I understand you are not a trained physician and 4 PT already didn't help. I'd like to know your opinion. Maybe I should do normal quadriceps exercises so that patella will move more laterally?

[@2fiafisdoafw34]

In which degree of the knee flexion is your tracking? Mine is in the last 20-10 degrees of the extension (rare), I can do deep squats and work quads without problem, but the quads deactivate around this degrees I mentioned and tracking becomes wierd and a little bit painful. It diminishes when quads get burning and pumped and when I stretch hamstrings (which I suspect provokes the bad tracking).

[@hamidman6974]

@@2fiafisdoafw34 exactly same as me. Which part of the quads deactivates? At first I thought my patella is tracking more medially. But I think it's actually tracking more laterally or maybe it's patella alta. How long have you had this problem? What more things are helping you? Lately I have been doing knee extensions focusing on the last few degrees and it seems like it is helping, but I am not sure. I went to 7 physical therapist/ doctors they all gave different opinion :((( What about sitting cross legged and leaning forward, does it help you? I remember a night in which I was stretching a lot. Especially hamstrings and sitting cross legged, and I felt like almost regular tracking, almost no click.

[@2fiafisdoafw34]

​@@hamidman6974 Mi patella is tracking more towards medially. I think is due to hamstring became overwhelming strong when my quad became weak and atrophied, because I got a patellar tendonitis years ago that lastes aproximately 6 months or more, patella tracking is about 4 years now. My knee was in really bad shape, I cannot walk or step up stairs properly without knee pain. I started doing isometric squats with the bad leg, and scaling up a little bit each time I felt better, in question of months I did controled lunges, and now I do deep squats, with the under medium and deep phases of the movement feeling the best for hitting the quads. Another exercise helped me a lot where ATG Split Squats (check out for a dude called "Knee over toes guy", many exercises he recommend helped to heal my knee), Landmine Platz Squats, even Sissy Squats doesn't hurt me, the worst exercises are the ones that hit the last parts of the knee extension (so quad extension are not for me). If stretches pulls your patella in place (likely my case), then do it before training, streches by itself without strenghtening and hypertrophying the weak muscle doesn't help too much. Search the pump when doing exercises, connection mind-muscle and everything bodydbuilders say when training. As your muscle became deactivated, you lose neural control over ir, you need to retrain it to obey. Don't care too much about the heads of the quad, because it cannot be isolated effectively, you can put more or less work in each of them relative to the kind of exercise done, but never isolate them, and, if the problem came for a overly strong hamstring or another muscle then the problem isn't your quad in itself.

[@hamidman6974]

@@2fiafisdoafw34 thanks for your detailed answer. Yes I watched almost all Kneesovertoes videos, I think he is an amazing guy and has amazing content, but I didn't see anything for patellar maltracking. Why your knee was bad? For me, my knee was always good, then from falling in football, this happened and I stopped playing now. Do you think it's ok to play football even with this tracking problem? Have you tried isometrics, (for example leg extensions hold right near where the tracking problem occurs)? What about shin training? Do you think that might help with the patellar training? Me I can do pretty much anything, just feeling a slight discomfort. I am afraid of playing football because if the patella keep maltracking at high frequency (sprinting) it might damage the cartilage. - that's what I thought. Is it correct? For the head of the quads - I activate the VMO by sitting kn6the on the floor, and touch with my hand. And doing mind body connection, I try to isolate and do isolated holds. Others suggest foam rolling the Vastus lateralis. I didn't do much of that yet.

[@devox8966]

hi so sorry to ask if i have bilateral patella maltracking is it recommend that to wear knee brace or not? because im thinking that my knee cap already started to shift to the side so maybe wearing a knee brace is not good? hope to hear from u soon!

[@Anartomy]

Hi, I'm sorry for seeing this so late! I'm afraid that my knowledge in this area is purely anatomical, not clinical, so I wouldn't be able to offer any advice about whether or not you should wear braces. If possible, I'd recommend speaking to a primary care provider about your issues. Sorry I couldn't be more help!

[@devox8966]

@@Anartomy sure thank you so much!

[@rosaliedejong9897]

Hi, when I keep my legs straight my kneecap goes far to the side, but medial. And when I bend my knees the patella goes completely the other way lateral. So like this: / from my perspective, for my right knee. That's kind of the opposite of what you're describing? or am I wrong? :p And do you know what could cause that? I have Ehlers Danlos Syndrome so I'm mostly hypermobile and I'm trying to figure out what goes wrong with my kneecaps. They have given me pain for more than 10 years now, and it gets harder and harder to put weight on them

[@Anartomy]

Hi Rosalie, apologies for the late reply! I'm really sorry to hear you've been having long-term problems with your knees. I'm afraid I'm not clinically trained, so wouldn't be able to offer you medical advice or treatment options. However, I can say this video was designed as an introduction to maltracking for medical students, so covers the most common mechanism of maltracking. But, as I understand it, medial maltracking can still occur, particularly following traumatic injuries, or in individual with loose ligaments - which could possibly relate to EDS? Sorry that I can't be more helpful - if possible, I'd recommend talking to a physiotherapist or physician and getting their opinions!

[@Mdirrp]

Pls At which age u are diagnosed with EDS , is it family history , do u have snapping sound caused by your tendons sliding on your joint bones ? And lastly how are your knee Ligaments (LCL , MDL , ACL , PCL) are they loose or strong? I really appreciate you if I get a reply Hope u reply Thank U

[@rosaliedejong9897]

@@Mdirrp I was diagnosed just this year, but I had symptoms from my knees since I was around 14 years old. We think it comes from my mothers side of the family. My knees produces a lot of sounds :') very hard snapping sounds, like 30 times a day. The last physiotherapist I spoke told me that my kneecaps go inwards, so medially, because of the loose ligaments. (don't know which one) And they move back when I use my leg muscles. So they move around a lot when I walk or do other stuff, and that gives a lot of pain

[@gunnar1846]

This is fine but you are forgetting that weak gluteals that cause a tight IT band can also seriously contribute. That is the main cause of my own tracking.

[@Wendythegoodlittlewitch17]

Anartomy?

[@Anartomy]

Hi Wendy - I'm a medical illustrator, so the channel name is a portmanteau of 'anatomy' and 'art' (but I can see why people think I've just made a spelling mistake!)

[@Dr.3orf]

I bear witness that there is no god but Allah, and I bear witness that Muhammad is the Messenger of Allah

[@nunchukGun]

I've seen you on more than one video now. Why are you spamming in the name of Allah?

[@Dr.3orf]

@@nunchukGun Because the West's information about Islam is wrong due to misleading media

[@andrewmartinez7559]

I’ve never heard a British person with a lisp before lol

[@Anartomy]

Hi Andrew, apologies for that. I'm deaf in both ears, so I'm afraid I have difficulty pronouncing some words ('lisp', ironically enough, being one of them). Hopefully you could still follow the content!

[@supermegaguy666]

@@Anartomy Ah shit that's rad, awesome video!

[@AmorFati777X]

What causes a really nasty crackling sound immediately following an injury acquired during unilateral squatting without any initial onset pain for a week?

[@Anartomy]

Hi Ben, I'm afraid I'm not clinically-trained, so can't give you an answer. But certainly, if its causing you pain, I'd recommend speaking to a health care professional about it

[@AmorFati777X]

@@Anartomy yes I have an apt but the wait is killing me. I suspect meniscus tear likely explanation. Thanks for replying to me. Great video