Patellar Tracking Disorder

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Topic Overview

What is patellar tracking disorder?

Patellar tracking disorder means that the kneecap (patella) shifts out of place as the leg bends or straightens. In most cases, the kneecap shifts too far toward the outside of the leg. In a few people, it shifts toward the inside.

Your knee joint is a complex hinge that joins the two bones of the lower leg with the thighbone.

• The kneecap sits in a groove at the end of the thighbone. It is held in place by tendons on the top and bottom and by ligaments on the sides.
• A layer of cartilage lines the underside of the kneecap. This helps it glide along the groove in the thighbone.

A problem with any of these parts in or around the knee can lead to patellar tracking disorder.

What causes patellar tracking disorder?

Patellar tracking disorder is usually caused by several problems combined, such as:

• The way your knee is formed. Things that can lead to a knee problem include having a small or flat kneecap, knock-knees, a very long patellar tendon, or a shallow groove in the end of the thighbone.
• Muscles in the front of your thigh (quadriceps) that are weak or out of balance. Strong quadriceps help hold your kneecap in place. But your kneecap can be pulled off track if the outer quadriceps muscle is stronger or contracts more quickly than the inner muscle.
• Ligaments, tendons, or muscles that are too loose or too tight.
• Damaged cartilage in your kneecap.

You are more likely to have patellar tracking disorder if you have any of the above problems and you are overweight, run, or play sports that require repeated jumping, knee bending, or squatting.

What are the symptoms?

If you have a patellar tracking problem, you may have:

• Pain in the front of the knee, especially when you squat, jump, kneel, or use stairs (most often when going down stairs).
• A feeling of popping, grinding, slipping, or catching in your kneecap when you bend or straighten your leg.
• A feeling that your knee is buckling or giving way, as though all of a sudden your knee can't support your weight.

If your kneecap is completely dislocated, you may have severe pain and swelling. Your knee may look like a bone is out of place. And you may not be able to bend or straighten the knee. If you have these symptoms, be sure to see your doctor. A dislocated kneecap needs to be put back in place by a doctor right away.

How is patellar tracking disorder diagnosed?

It can be hard to tell the difference between patellar tracking disorder and some other knee problems. To find out what problem you have, your doctor will:

• Ask questions about your past health, your activities, when the pain started, and whether it was caused by an injury, overuse, or something else.
• Feel, move, and look at your knee as you sit, stand, and walk.

You may have an X-ray so your doctor can check the position and condition of your knee bones. If more information is needed, you may have an MRI.

How is it treated?

Patellar tracking disorder can be a frustrating problem, but be patient. Most people feel better after a few months of treatment. As a rule, the longer you have had this problem, the longer it will take to get better.

Treatment of patellar tracking disorder has two goals: to reduce your pain and to strengthen the muscles around your kneecap to help it stay in place. If you don't have severe pain or other signs of a dislocated kneecap, you can try home treatment for a week or two to see if it will reduce your pain.

• Take a break from activities that cause knee pain, like squatting, kneeling, running, and jumping.
• Put ice on your knee, especially before and after activity. After 2 or 3 days, you can try heat to see if that helps.
• Take an over-the-counter pain reliever such as ibuprofen or naproxen to reduce pain and swelling. Read and follow all instructions on the label.

As your knee pain starts to decrease, do exercises to increase strength and flexibility in your leg and hip. Your doctor or a physical therapist can help you plan an exercise program that fits your condition. You will probably start with one or two exercises and add others over time. Make sure to closely follow the instructions you're given.

Your doctor or physical therapist may also suggest that you:

• Tape your knee to hold the kneecap in place.
• Use a knee brace for extra knee support.
• Try shoe inserts (orthotics) to improve the position of your feet.

Most people with patellar tracking disorder can slowly return to their previous activity level if they:

• Avoid movements that make symptoms worse.
• Keep doing their stretches and strength exercises.
• Learn the best way to do their sport and use the right shoes or equipment.
• Lose excess weight.

Surgery usually isn't needed for patellar tracking disorder. You may need surgery if your kneecap dislocates many times or other treatments haven't worked. There are several types of surgery that can correct a tracking problem. You and your doctor can decide which surgery is best for you.

Can patellar tracking disorder be prevented?

Sometimes knee problems run in the family. If a family member has knee pain, you may want to take steps to help prevent this problem.

• Avoid activity that overloads and overuses the knee.
• Keep the muscles around your knees and hips strong and flexible.
• Stretch your legs and hips well, both before and after activity.
• Do activities that work different parts of the leg, especially if you're a runner. Cycling and swimming are good choices.
• Stay at a healthy weight to reduce stress on your knees.