Patella Alta | Expert explains Diagnosis, Assessment and Treatment

In this tutorial, using our 3D anatomy models we explain what the condition Patellar Alta is. We explore how it can present including associated complications and how it is diagnosed on X-rays. We guide you through the treatment of this condition, including suitable exercise plans for your patients.
References
Stefanik et al., 2010: doi.org/10.1002/acr.20214
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[@harinu9339]

I have patella alta and love this video! I was diagnosed a few months ago, after spending my childhood and teenage years in pain and being called a liar or told "you're too young to have a knee problem 🤓” it's reassuring to know what I have, what I can do about it and how I need to adapt my life. It bothers me because I'm going to be a professional in the equine industry, but I'll deal with it. My sports doctor prescribed physiotherapy, and the first physio I went to wouldn't look at the doctor's diagnosis, and literally told me why I was in pain without even asking me. Against the doctor's instructions, he told me to run and do as much cardio as possible, but definitely not leg extension because "it's crap" according to him. He told me that the only reason I was in pain was because I was fat (I've been fat for 1.5 years, but I've been in pain for 14 years lol) and when I told him to look at the diagnosis, he said that the reason my trochlea wasn't very deep is because I wasn't active enough as a child. 💀 Like, I'm a country kid, I did five different sports when I was younger: horseback riding, tennis, ballet, athletics, sailing.. And bike hiking every week-end, and as a teenager weight training. Is that an inactive kid? 😂 I had to quit each of these sports because of pain, and I was able to start riding again in dressage, and weight training under the supervision of my new physio who respects me and has explained to me what I have and how to help me. I hope I will be able to run again soon, because oh I miss a good sprint. I'm actually glad I trusted my instincts and changed physiologists, even though I had to wait 3 months for an appointment and I'm the "extra patient" (they didn't have room but had pity and took me lmao). He makes me do this great exercise on the machine, leg extensions but as slowly as possible, then I have to stay 20sec at 0°, then at 20°, 45°, 30° and we start again! It has helped me a lot, and as I have home gym I am progressing fast.

[@jamesrryan1]

Thak you Khalid! You always revive my interest in physio even when I hit fatigue during my studies. Such a lovely energy and clear communication

[@ClinicalPhysio]

Thank you so much James! Wish you all the very best and keep going!

[@pmoneyyy15]

Very interesting video to watch! I got diagnosed last July when I dislocated my knee for the first time (sitting on a couch 💀) and had to go to the hospital I was in so much pain they had to put me up. I found out when I went to the doctor after, and even found out that my previous knee doctor had made note of me having this without saying anything to me/my parents! (I had chipped/broken my knee when I was around 7 I believe) It was somewhat devastating to find out this might’ve been able to save me so much pain growing up. I’ve been trying to find out more stuff about it because I’ve felt like I’ve not understood it at all. I’ve also have a huge problem with knee locking (why I think I had dislocated my knee when I went down) and I’ve wondered if knee locking and patella Alta coincide (I’ve asked my dr. And he literally said “could be” and my PT hasn’t really said anything despite my asking…) I’ve been locking my knees my whole life and I’m wondering if it’s a problem I can change to help my patella Alta without surgery or if it’s a different problem, etc.

[@jonjeffers5153]

@ClinicalPhysio great video. Does the angle of the bent knee factor in?

[@ethanshaw3377]

Can a knee brace of some sort help with patella Alta during sports like snowboarding or skiing?

[@Larki13]

Folks diagnosed, do you particularly get knee pain when your legs are bent? My knees only really hurt (quite badly!) when they're bent like when I'm trying to sleep on my side or if I'm sitting cross-legged or with my knees bent under me in any way. But the only thing "wrong" on the x-ray was patella alta in both knees.

[@joshuaparkes6504]

Great video thank you! You mentioned that prehab is obviously very important for quad strength/activation, do you think we also could include quad stretching exercises to increase ROM for the distalisation procedure? Thanks

[@ClinicalPhysio]

Hey Joshua! Great question… ultimately, stretching doesn’t tend to be used… Rather than increasing length of tissue to help with distalisation, the focus tends to be on ensuring good PF control as you said 😊🙏🏼

[@monoklica]

I'm 3 months post surgery and I can do a leg lift but what it does is my outer quad pulls patella slightly outwards and my VMO is still really weak. Can you recommend some other exercises for VMO? Leg extensions I can do also, but the pain is still excruciating when I go to a full ext :( tnx On the other hand squats don't cause any problems, I can do them, also wall sits.

[@imhoturnot09]

Almost 43 and just had some X-ray results with this diagnosis and OA. Explains a lot

[@ClinicalPhysio]

🙏🏼 wishing you all the best

[@randileeshelton]

I am 43 and was just diagnosed with this week.

[@panagiotiskapodistrias9817]

Thanks a lot , easy and helpful!

[@ClinicalPhysio]

Efschiaristou!

[@Artosification]

Great video! Could you recommed some precautions against a dislocation in patients with more frequetly sublaxations?

[@ClinicalPhysio]

Hi! In some patients I have seen a hinged knee brace used as sometimes the rotational element can influence dislocations. This isn’t necessarily something I would recommend but I have seen it used on a few rare occasions. Quads Strengthening prior to surgery always a good idea too

[@ranidushaminda]

Thanks a lot for these information.

[@ClinicalPhysio]

My pleasure! Thank you for watching!

[@Kenziesmidnights]

I’m 15 and do gymnastics and have dislocated my patella 3 times i got a MRI and got diagnosed with patella Alta i had surgery but not fix it, it was an arthroscopy to remove a loose piece that had broken off.. I haven’t been to gymnastics for 4 months.. do you think i will be able to go back? I’m doing physio but thats to help my leg be able to fully extended again. I would love to hear from you! 😊

[@user-wy9ep8xq2c]

Im looking for a good brace for patella alta. Any ideas?

[@hamdijama6429]

I’ve developed patellar Alta after a dislocation, I’m confused because I can’t raise my leg however I can straighten it and bend it, my injury happened 2months ago and I’ve done no exercises so could that just be because of weak quads?

[@OmkaR-lg2nt]

Hi doc I have patella alta on both my knees. Insall salvati ratio is 1.85 and my height is 6 feet 2 inches. Dislocated my right knee cap last year but right now doing good. Guide me if I will face any knee related problem in future

[@wakeupandroar3488]

Thank you for this very well explained video. They say I have patella alta 1.5 and subluxation... I was of course recommended surgery, but until now I have read too many comments on different videos of people who felt worse after the surgery and too few who felt better after. So I don't really feel optimistic and confident doing it... If anyone got their life back after surgery and feel better, please share..

[@abhiverma4048]

Is your knee ok now

[@wakeupandroar3488]

@@abhiverma4048 hey there.. I have been doing physio and muscle strengthening exercises (glutes, hips and VMO) and although it exposed some of the problems I have in my hips, the knee stopped hurting and feels a bit more stable..

[@liverleef]

Thank you so much for this helpful video. I've found that straight leg raises have helped my patella alta tremendously. My knees however, are still inflamed if I engage in any cardio exercises such elliptical or cycling. Rowing is slightly better. What forms of cardio do you recommend to your patients?

[@sarahkottke676]

Rowing is okay for you too? I'm a cyclist and my knees are struggling with higher resistance training.

[@liverleef]

@@sarahkottke676 yeah, rowing focuses less on the quads and more on the hamstrings/glutes compared to cycling.

[@sarahkottke676]

@@liverleef winter cycling tights really irritate my knee caps? Have you found this to be the case? Any other exercises that you have found to be helpful. I really want to avoid surgery though want to maintain the highest level of activity I can without worsening my knees.

[@nancygreen4201]

Hi I just got diagnosed with patella Alta in November my primary told me to buy better shoes, well 5 months later and my swelling is non stop, how do I know if I’m still in my early stages?

[@heejinsohmygodyes6186]

Thank you so so so much!!!

[@ClinicalPhysio]

🙏🏼🙏🏼🙏🏼

[@Jessica-kg1sr]

My patella Alta is at a 1.8 ratio. Is fixable with physical therapy? Hoping to not get surgery. I also have quad atrophy

[@brettnicol899]

Great video! Thank you. I'm 8 weeks into a mysterious knee clicking on my left side. No pain but I can't go upstairs or squat without very loud clicking. After multiple doctor and physio trips I got an MRI which said I have patella Alta ISR 1.5, oedema of Hoffas fat pad, small bursal effusion, small baker's cyst and very minor retropatellar cartilaginous fissuring. I'm 27 and have never had any issues with my left knee. I recently got back into gym and running and think that has caused the clicking. As I've never had issues ever with clicking, could it be that the patella Alta isn't genetic? I've always been very sporty and I've never dislocated it. Could the fat pad swelling cause the patella Alta? I've seen my doctor and physio multiple times but haven't been given much information

[@Canuck037]

Its not always genetic im 21 and always played sports, but with covid I stopped doing anything leading to me having weak knees, I started to do flooring for a company and now have pattela alta after 6 months of trying to figure out what this pain was, it is most definitely not genetic in my case so I doubt it is with you especially if you've always been active, doctors and physical therapists also could never tell me what the issue is, pretty much found this out myself when I felt and noticed one kneecap is higher then the other.

[@natasha4880]

i’m 16 and i have patella alta in my left knee (not sure about my right as haven’t had that checked). it dislocated when i was 14 and had an x-ray to confirm it. it’s definitely tough but i haven’t had surgery, i’ve been in physio for 2 years and have got muscle wastage still which sucks lmao. this video definitely helps explain it though!!! my doctor said i’ll get surgery if it dislocates a second time

[@ClinicalPhysio]

🙏🏼🙏🏼🙏🏼 wishing you all the best!

[@timonbubnic322]

Dude i played basketball all my life and started getting knee problems at 16-17, my tendons are so much weaker bcz of patella alta and bcz at that time i was training the most, i developed tendonitis several times, now my left patellar tendon is so fucking weak and im lost in life, this shit ruined everything, i spent thousands on rehab, it got marginaly better, now 2 weeks into practice and it inflamed again, now idk what to do anymore and will probably have to quit

[@ClinicalPhysio]

@@timonbubnic322 you absolutely don’t have to quit my friend - have definitely seen people in similar positions with basketball and patella tendon pain which improves and they get back to it!

[@lindalucas6318]

@@timonbubnic322 you could try excluding foods such as dairy. It sounds strange that foods could cause tendons and joints to become weak and inflamed but what have you got to lose?

[@beccakash284]

Thanks so much!!

[@ClinicalPhysio]

🙏🏼🙏🏼🙏🏼 thank you for watching!

[@deonnu5648]

I have patella alta after I dislocated my knees three times in a day. I was shocked when my ortho told me that I didn’t need surgery and now i’ll start my rehab next week. Hoping that i’ll recover fast 🤞🏽

[@ClinicalPhysio]

Wishing you all the best!

[@abhiverma4048]

Is your knee ok now

[@dianaelena4228]

how are you now? has physical therapy helped?

[@truthserum8326]

Could a sharp upward blow to the knee cap when the leg was bent (extremely painful when it occurred) cause patella alta without a rupture of the patella tendon?

[@ClinicalPhysio]

Ultimately I suppose anything is possible, but I would imagine this would be less likely that this creates long term patella Alta…. Always happy to be proven wrong though!

[@laceysmith7447]

I have dislocated my knee, three times and have severe knee pain and I got diagnosed with this last year. I really want to get the surgery but I still haven’t seen an orthopaedic surgeon

[@ClinicalPhysio]

Wishing you all the best and hope you get to see one soon

[@harshabhigyan928]

Great video. Is surgery the only option? Or can it be treated without as well?

[@ClinicalPhysio]

Thank you! Ultimately it depends on symptom severity - if someone has not many symptoms of pain or dislocation, or if they feel that they are “coping” with their symptoms then it is not always mandatory to have surgery

[@harshabhigyan928]

Hey Doc! Its been an year but thanks for the answer! Ive had no dislocations since 3-4 years! 3-4 years ago both my knee bones dislocated 1-2 times each within a single year. I went to many doctors and one of them said i needed to get operated. However corona came and i couldnt. Since last 3 years i have been doing squats, extensions and regular exercises and am feeling no pain. It just kinda clicks whenever I squat and stand back or feels kinda lose when i suddenly run really fast. Because of the mental trauma from so many past dislocations, i still have fear that if i play football, or if there is a sudden sideway force (as with football or some other sports) it might come off. I know im ranting at this point but what do you suggest should I do?. Thanks once again doc 🙌

[@eyoelwendwosenfeleke225]

Hey there, Thank you for this explainer video, it's detailed and concise. A month ago, I've been diagnosed with Patella Alta on my right knee with ISR value of 1.3 by MRI. I can do perform quad and hamstring exercises, but I feel some kind of stiffness and sometime very mild acute pain, and when I perform squats I feel my exterior ligament/tendon snap into some position. My doctor told me to do leg VMO strengthening exercises and I'm doing that but Should I stop doing leg exercises? And I would love if you make a video on VMO strengthening exercises.

[@ClinicalPhysio]

Hi Eyoel! Thank you so much for your kind words! I suppose natural first suggestion would be just doing the squats but not quite going down as far so that it does not cause you too much issue. Over the internet of course it’s hard to suggest what the snapping feeling you are experiencing is, it could be nothing to worry about at all, but would prefer to suggest you are assessed for this before taking my specific advice! 🙏🏼 good luck!

[@natl2493]

Thanks for your explanation! I am female 35 y o and had pains in my right knee while up and down the stairs. Left one is OK. Small pains first appeared last summer and I just made more gymnastics and walking. But since this Jan it became very painful. Yesterday made MRT and result is patella alta, all other is OK with my knee. I wonder, could patella alta be the reason that I do not feel targeted muscles in classic positions in the gym? I mean stepping on the cube, classic squats, lunges - I always mainly feel quads, not hips and glutes. My legs are not long (my height is 164 cm) and maybe all this effects biomechanics of gym excersices...

[@natl2493]

insall salvati 1.4

[@OmkaR-lg2nt]

@@natl2493 mine is 1.85 and my height is 6 feet 2 inches

[@ihaveaidsish]

Hey there, I had an mri and my physio said my patella is sitting a bit too high and it hurts if I do leg raises. He simply said to go away and do some quad stretches for a month and then come back... And yes I'm also leg extension... Is this correct? Cheers

[@asharedo]

"ultimately, stretching doesn’t tend to be used… Rather than increasing length of tissue to help with distalisation, the focus tends to be on ensuring good PF control "

[@paddybrady5874]

Any luck with exercises I been told the same

[@toniobr76]

​@@asharedowhat mean PF ?

[@iampjdon]

I have a MRI scan and radiologist reported "Mild Patella" with ISR 1.28. But I have no pain during knee extension or any other exercise. What would you suggest? Thanks.

[@ClinicalPhysio]

Of course discuss it with your doctor as primary answer! But my first thought would be that the fact that you don’t have many symptoms is a pretty big factor in how much to (or how much not to) disrupt things!

[@TheSonic1685]

I've gotten diagnosed with patella alta, and a lateral patella position towards the outside of the the knee. I've had 4 dislocations so far and my trochlea is experiencing cartalage damage. I also have valgus knee deformity. Some say there's nothing wrong, no surgery and excercise only as surgery is too risky and can't be undone, others say prehab excercize for the surgery. I just want my knee cap to stop dislocating and I want to get back to training again, it's miserable.

[@ClinicalPhysio]

So sorry to hear your troubles and wishing you all the very best

[@immelis]

i have patella alta in both of my knees, i passed an operation and it worked well, i am really hopeful to another one. i wish the next operation would be fantastic

[@ClinicalPhysio]

Wishing you all the very best with it!

[@user-fc1fh6tp1k]

do you have well results after surgery?

[@lovrebrajkovic4094]

One of my doctors recommends mpfl surgery for my alta patella and the other suggested a TTO surgery.What surgery did you have.

[@anacarreon3375]

This helped me so much! Also I have a question, if I got diagnosed with patella alta as a consequence of a patellar tendon rupture surgery, will it get in the right place again? Before the lesion my patella was in the 'normal' place.

[@ClinicalPhysio]

Are you having the surgery? Have you spoken to your surgeon about this? Very important to have these discussions with them

[@anacarreon3375]

@@ClinicalPhysio I already had it last year, my surgeon says that I will probably need another surgery but I'd like to try other options before

[@MrXmannymanx]

@Ana Carreón hey Ana I'm in the same boat Had bilateral ruptures and my left knee feels like the patella is riding high How are you doing now

[@anacarreon3375]

@@MrXmannymanx Hey! It seems that my quadriceps was too weak when I started to move again, so the patella couldn't get back to its original place and all of the other muscles around have been doing the entire work. I'm focus now in strenghtening the quad to see if it gets better.

[@MrXmannymanx]

@@anacarreon3375 when you stand Does your quad look weird where it meets the patella? Does your quad feel weird right above your knee cap?

[@princeloverys]

I got diagnosed with this, and I’m so glad. I’ve had it since I was 11 and I was always in pain and like at school in PE no one believed me. I was constantly in pain and all doctors kept saying “infections” and “physical therapy is the best solution” I went to 3 specialist and the last one diagnosed me Monday. On 30th of June I’m getting operated 🫶🏻

[@ClinicalPhysio]

Wishing you all the very best!

[@gokcenacar3523]

omggg my surgery is in december and i’m soo nervous. can you tell me how yours went 🙃

[@princeloverys]

@@gokcenacar3523 it went amazing, recovery in the beginning is difficult I must say. Definitely get wheelchair and crutches. I'm 2 weeks in and just came back from my appointment and everything is going very good. I wish you the best for your surgery!

[@lienphan1620]

@@princeloverysI’m so happy to hear that your recovery is going well. Feel free to give any updates. My 11 year old had her first dislocation a couple months ago. We got x-rays and saw an ortho because like you, I was not believed by adults in my childhood. (I was just diagnosed with hypermobile Ehlers Danlos syndrome last year). I’m so glad I pushed for an MRI. She has PTD from patella alta, and trochlear dyplasia. I see the ortho tomorrow. I hope to keep her from experiencing the hundreds of dislocations, the pain and the gaslighting I endured. Best of luck to you ❤

[@Jessica-kg1sr]

@@gokcenacar3523how are you prepping for surgery? May I know the name of the surgery you're getting

[@lakiacooper7340]

Any stretching techniques for a High Patella Alta? Mines are sitting very high on my thigh bone. Both my left and right knee caps pop out when I walk or standing. They don't lock in place like a normal knee cap should. I want to wear shorts, dresses and skirts but I don't like the way my knee caps look as they drop out and not locked in place. I am not having any pain. Its been this way since I was born. I am not looking to get surgery on them either.

[@ClinicalPhysio]

Hello! Are you planning to start physiotherapy in your local area for this? I would highly recommend it

[@lakiacooper7340]

@@ClinicalPhysio I never heard of Physiotherapy. Do they offer it at a Physical therapy clinicals? If so I will look into it. Thank you for the recommendation! :)

[@ClinicalPhysio]

@@lakiacooper7340 yes absolutely!

[@allymcginley4882]

I had 3 knee surgeries from my patella Alta with over 10 subluxations on my right knee since I was 10 and my left knee still dislocated even after surgery 😩 this injury is such a pain

[@ClinicalPhysio]

Wish you all the very best Ally

[@Jessica-kg1sr]

How bad was your patella Alta? My ratio is 1.8 :( also what surgery did you have?

[@medalii7987]

hello , The congenital Type of Patella Alta , is it Bilateral or it can occur only in one Knee ?

[@ClinicalPhysio]

Good question! It is very very rare and so I don’t think there is much evidence to suggest it can only be one knee, or that it is always both knees

[@vela7447]

​@@ClinicalPhysio How rare is it?? I have it in both knees, and probably something wrong with connective tissue. My dad's knees started to go by the age of 20 as well

[@lovrebrajkovic4094]

Went to 2 different doctors and nether said i have patella alta but said that my patella sits to high and outward.one suggested mpfl reconstruction and one suggested tto surgery.what should i do.I had 6 dislocations in the past 7 years andmy cartlage is starting to wear down othe outter side of my knee.

[@ClinicalPhysio]

I’m sorry but without being able to assess you it would be very unwise for me to give you advice

[@dazzlingpumppouches]

I just got dxd with this. I had a right knee replacement 5 months ago and because my left leg took the brunt all those months resulted in this.

[@ClinicalPhysio]

Hope you are able to make progress 🙏🏼

[@kwame4973]

Can physio alone treat the whole thing, or does it only help with pain and stability?

[@ClinicalPhysio]

Ultimately it won’t change alignment significantly… but the point is that if the symptoms improve then the exact degree of alignment is far less relevant

[@kwame4973]

@@ClinicalPhysio oh okay I get it. Thanks for letting me know!

[@ClinicalPhysio]

@@kwame4973 no problem!

[@ashikmohammad1232]

My left leg does not move. It has to be kept straight all the time. In this situation my normal life is disturbed. I can't bending my left knee. Probably the patella in my left leg is just above the knee joint which I think is the patella alta. I need treatment. In such a situation which doctor can I consult.?? please reply...

[@ClinicalPhysio]

Please May I suggest seeing your local family Dr to start with, or a physiotherapist, to be able to help you with the first steps

[@sitarambharadwaj2559]

Can we do taping for this patella alta,? Is it usefull

[@ClinicalPhysio]

Hi! As a long term solution, probably not

[@sitarambharadwaj2559]

@@ClinicalPhysio oh ok thank you than, solution will be only surgery? Coz my client suffering this sence long time i tried exercise and all but not much effective, what will be the solution for pain relief

[@Riiotking]

My doctor told me there is nothing they can do for patella Alta, i have it in both knees. The cracking had become so bad, when I walk up stairs it sounds like rice crispy. This pain is horrible. I just want the pain gone already.

[@ClinicalPhysio]

🙏🏼🙏🏼🙏🏼 wishing you all the best and hope things resolve soon

[@Eldy-w]

I have patella alta and the pain comes and goes. I’ve dislocated both my knees on separate occasions, but after some physiotherapy it is much better. I think going on lots of walks helps as well.

[@ClinicalPhysio]

Thank you Luke! Wishing you all the best 🙏🏼

[@dianaelena4228]

How much physiotherapy did you do to relieve the symptoms?

[@Eldy-w]

@@dianaelena4228I did 1 session a week for 3 months with a physio through the NHS and then kept up some more for a further 6 months at home. Now I just try and walk a lot and do some light exercise occasionally.

[@vlaerenko]

Is an injection of Hyaluronacid something that could really help the maltracking and Patella Alta? I hear the positive outcome of it is marginal?

[@ClinicalPhysio]

I would be sceptical personally I’m afraid

[@mohammedili8254]

Is knee cracking sounds a symptom for patella alta?

[@ClinicalPhysio]

No not specifically, it could be simple patellofemoral pain without patella Alta and this is no problem

[@bearc5737]

Iv just been diagnosed with patella alta at age 40 I am also hypermobile so i was wondering if there was a connection with that

[@ClinicalPhysio]

Yes quite possibly!

[@wakeupandroar3488]

same..

[@bearc5737]

@wakeupandroar3488 I found out it is connected as the tendons in hypermobile people can be to long which effects where the knee sits

[@wakeupandroar3488]

@@bearc5737 makes sense.. I have had all sorts of joint issues because of it..

[@user-vk7wj2zv6n]

I have Insal Salvati ratio: 1.8 do i have patella alta?

[@Jessica-kg1sr]

That's my measurement too and my MRI states that measurement is patella Alta.

[@MemeHub1914]

I have a case of this. Exactly the same issues. I feel embarrassed about it because I can't do sports😢

[@MrHitCrit123]

Hey, great Video. Sadly in Germany this is not a big topic. I have a patella alta, from that i got a cartilage damage. I need to train my legs to stabilize my knees but if i do stuff like leg press my knee will hurt and i am scared that my cartilage damage will be even worse. If i do lower weight and a lot of reps it will be too easy, if it is just a little bit harder (and this is where the muscle will grow) it starts hurting. I dont care about the hurting, but about my cartilage damage. I am 20 years old, please please please tell me what i should do. I would love to get big legs because i started body building. I tryd once leg extension but i hurt too and my doctor said this is should be the worst exercise for the knee. (If i massage my patella and press it down it will hurt a little bit less and later when i do leg press)

[@brendadani3431]

I have the same problem :(

[@timonbubnic322]

Same but for basketball, need to strenghten my quad if i ever want to train consistently again, yet any exercise a little bit harder hurts me, i almost gave up. And also i probably have 0 cartilage left tbh, my knee pops every time i bring it all the way in

[@reinerheiner1148]

If you get inflammation after training, this will shut down your vastus medialis, meaning that the patella will be less pushed towards the other leg and thus move more to the outside. This in turn will result in more inflammation and create a self-strengthening cycle of pain. So whatever you do, make sure you do not increase pain and especially pain after your workout as this will just make things worse. If you want big quads, you can always just concentrate on the part of the movement below and above the angle that hurts you. You should also work on increasing your ability in the painful angle, but you need to be extra careful not to inflame your joint. One tip is that you focus on the concentric part of the movement, because as the patella moves through the trochlea it is guided by the trochlea, until it leaves the trochlea, so positive movement out of the trochlea may be much more manageable and you can use this to rehabilitate your knee in that normally painful angle. Now consider the opposite part, moving your patella into the trochlea (so starting from a fully extended knee) - it is much more painful because your quads have to be extra precise to keep the patella in the middle so it perfectly enters the trochlea. And since you are already experiencing pain chances are that part of your quads, the vmo, is shut down to some degree already making precise patella movement essentially impossible - so thats why you should work mainly on the positive part of that movement. You could get a brace for your knees, like "ottobock patella pro", that aims to push your patella more medially, thus helping when the vmo is not working as strong as it should. I am assuming though, that you have lateral tracking of the patella, because this is normally the case when inflammation starts but of course you should be checked out by an md. The md can prescribe you that brace too, which I would suggest, because its very expensive (around 600€ for both knees). You can test however, if you have too much lateral tracking by pushing your patella towards the other leg while moving it through the painful angle. If it gets better that way, you probably have a lateral tracking issue. I know this situation sucks, I am in the same boat. Because of patella alta, our quads have to be extra precise in tracking the quads compared to normal knees which is a recipe for disaster once there is inflammation in the knee. But whatever you do, keep training your quads in the pain free ranges, and in the problematic ranges with weights that do not produce pain. Also work on having glutes that are strong and activate properly during exercise and everyday movements, to get pressure of your kneecap, and on external hip rotation and on having a proper arch on your feet (if you have flat feet) to help your body track the patella medially. while you absolutely should have strong hamstrings, you should be mindful that your hamstrings do not compensate for weak glute activation. You need to think of the pain in your knee not only as a problem with your knee, but also about a problem in the whole movement chain of the knee, which means proper hip and ankle movement as well as proper foot form. Any fault in those structures will, especially for patella alta, be very problematic.

[@reinerheiner1148]

@@brendadani3431 check out my reply below

[@reinerheiner1148]

@@timonbubnic322 check out my long reply to NostaleCaptain. But in addition to that, popping can also be caused by other structures in the knee, and even if it is caused by damaged cartilage, it does not mean it is gone yet. Leave that diagnosis to an MRI. Especially for any sports like basketball it is extremely important that you not only focus on the knee, but also on optimal hip, ankle and foot biomechanics. You can get a lot of pressure off your knee if it is good (and if the glutes do most of the work while you are playing). Also consider supplementing with glycine and a collagen hydrolysate powder, to support the cartilage that is still there. One tip to improve inflammation that made a huge difference for me was rose hip powder, but it alone will not help you get back into sports if you dont follow the other guidelines I have laid out. Good luck! I know what you are going through.

[@nic9972]

my doc said it is a genetic prob and likely both knees but i knocked my kneecap hard and am convinced this is the actual cause...thoughts?

[@ClinicalPhysio]

Genetics is often more likely but do you actually have Patella Alta? Naturally the opinion of someone who can assess you properly will be better than my opinion over the internet 🙏🏼

[@nic9972]

Thanks for respoinding. i do. I was diagnosed in one knee and they want me to have a scan of the other knee. They said only option is surgery without any suggestion of PT or exercise...seems aggressive way to treat without trying any other methods@@ClinicalPhysio

[@Cactoida]

I’ve got this in both kneecaps dislocated both not nice I’m 17.

[@ClinicalPhysio]

Wishing you all the very best 🙏🏼

[@lindalucas6318]

Many top athletes try vegan diets for optimal performance

[@ClinicalPhysio]

That’s interesting!

[@pabloharris7371]

So it’s basically jumpers knee? I have it in both knees but it doesn’t hurt when I exercise and I’m very active can this disqualify me from the military?

[@ClinicalPhysio]

I’d say it was quite different to Jumpers Knee (patella tendinopathy), but I would definitely speak to the military you wish to join for a more definitive answer