• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
bone and spine logo

Bone and Spine

Your Trusted Resource for Orthopedic Health Information

  • Home
  • About
  • Contact Us
  • Policies
  • Show Search
Hide Search
You are here: Home / Sports Injuries and Rehabilitation / Patellar Maltracking

Patellar Maltracking

Dr Arun Pal Singh ·

Last Updated on August 1, 2019

Patellar maltracking is said to occur when the patella does not move within the patellar groove of the lower femur. The patella is a sesamoid bone contained within the quadriceps tendon [the portion between the patella and tibial tuberosity is called patellar tendon]. The movement of the patella and its tendon is greatly influenced by forces around it.

Patellar maltracking is one of the important causes of knee problems. Patella or kneecap bone is moved by actions of quadriceps femoris which is composed of four different parts. Two of these parts are named as vastus lateralis and vastus medialis, and pull the patella during the knee movement to lateral and medial side respectively.

An imbalance of these forces is a very common cause of patellar maltracking.

Mostly, it is the vastus lateralis [lateral or outer pull] which is overactive and stronger than the vastus medialis [medial or inner pull]. Due to this imbalance, the patella gets pulled out of the groove resulting in increased friction with the femur and eventually pain.

When the forces are too unmatched, even patellar dislocation could result.

Contents hide
1 Causes of Patellar Maltracking
2 Assessment of Maltracking
2.1 Q angle
2.2 Tibial Tubercle – Trochlea Groove Distance
3 Patellar Maltracking Treatment

Causes of Patellar Maltracking

Maltracking of the patella may be caused by various factors –

  • Muscular imbalance
  • Joint surface malalignment
  • Excessive knee valgus [increases lateral forces]
  • Quadriceps contractures
  • Joint overuse
  • Excessive loading of joint
  • Relatively flat patella
  • Patella alta (high-riding patella),
  • Shallow femoral trochlea
  • Femoral torsion
  • Loose medial structures
  • General joint laxity

The most common form of malalignment is rotational malalignment, whereby the patella is tilted.

Assessment of Maltracking

Patellar maltracking or malalignment is assessed by measurements on radiographs and CT.

Q angle

Q angle is the angle between a line joining the anterior superior iliac spine and the center of the patella, and a line joining the center of the patella and the tibial tuberosity. This reflects the degree of valgus force upon the patella. The normal value is about 15 degrees. A large Q angle is a predisposing factor.

Tibial Tubercle – Trochlea Groove Distance

Tibial tubercle trochlear Groove measurement for patellar maltracking

The trochlear groove is the concave surface where the patella makes contact with the femur. Tibial tubercle – trochlea groove distance compares the position of the trochlea groove with the tibial tubercle. Two axial CT slices are superimposed, one at the level of the trochlear groove and the other at patellar tendon tibial attachment distance greater than 1.8-2 cm has high specificity for maltracking.

Patellar Maltracking Treatment

Most of the cases of patellar maltracking are managed by nonoperative treatment. The strategies and options include

  • Relative rest – curtailing and modification of activity
  • Quadriceps strengthening
  • Icing of the knee after the activity
  • Footwear modification
  • Drugs for pain like NSAIDs
  • Hip, hamstrings, iliotibial band and claves stretching
  • Orthotics
  • Taping of knee

Treatment needs to be individualized.

Surgery may be considered when the patient does not improve on nonoperative treatment and consist of procedure that addresses the cause. For example, the lateral release is done for muscle imbalance. Arthroscopic procedures may be done for joint pathologies.

Sports Injuries and Rehabilitation This article has been medically reviewed by Dr. Arun Pal Singh, MBBS, MS (Orthopedics)

About Dr Arun Pal Singh

Dr. Arun Pal Singh is a practicing orthopedic surgeon with over 20 years of clinical experience in orthopedic surgery, specializing in trauma care, fracture management, and spine disorders.

BoneAndSpine.com is dedicated to providing structured, detailed, and clinically grounded orthopedic knowledge for medical students, healthcare professionals, patients and serious learners.
All the content is well researched, written by medical expert and regularly updated.

Read more....

Primary Sidebar

Know Your Author

Dr. Arun Pal Singh is an orthopedic surgeon with over 20 years of experience in trauma and spine care. He founded Bone & Spine to simplify medical knowledge for patients and professionals alike. Read More…

Explore Articles

Anatomy Anatomy Fractures Fractures Diseases Diseases Spine Disorders Spine Disorders Patient Guides Patient Guides Procedures Procedures
featured image of gower sign for segmenatal instability of lumbar spine

Clinical Tests for Lumbar Segmental Instability

Lumbar segmental instability may not always be visible on standard …

mesurement of scoliosis for braces

Braces for Scoliosis- Types, Uses and Results

Braces for scoliosis are recommended to prevent the scoliotic curve …

discogenic back pain

Discogenic Back Pain Causes, Diagnosis and Treatment

Discogenic back pain is a common cause of axial low back pain [the …

Elbow arthrodesis using internal fixation

Elbow Arthrodesis- Indications, Methods and Complications

Elbow arthrodesis refers to the surgical fusion of the elbow joint. It …

skeletal traction in upper tibial pin

Skeletal Traction – Indication, Uses and Complications

Skeletal traction is a type of traction where the force is applied …

Popular articles

Bone Mineral Density

Bone mineral density or bone density is …

rotator cuff anatomy

Rotator Cuff Anatomy and Significance

The rotator cuff is a group of muscles …

mesurement of scoliosis for braces

Braces for Scoliosis- Types, Uses and Results

Braces for scoliosis are recommended to …

atlanto-occipital fusion

Atlanto-occipital Fusion or Occipitalization of Atlas

Atlanto-occipital fusion or …

Bone and Spine

© 2025 BoneAndSpine.com · All Rights Reserved
The content provided on BoneAndSpine.com is intended for informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Read Disclaimer in detail.