Discusses patellar tracking disorder, a problem that causes kneecap instability. Covers causes and symptoms. Covers treatment with physical therapy and surgery for severe cases. Links to exercises that can be done at home.
Patellar Tracking Disorder
What is patellar tracking disorder?
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
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
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:
Weak thigh muscles.
Tendons, ligaments, or muscles in the leg that are too tight or too loose.
Activities that stress the knee again and again, especially those with twisting motions.
A traumatic injury to the knee, such as a blow that pushes the kneecap toward the outer side of the leg.
Problems with the structure of the knee bones or how they are aligned.
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.
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
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:
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
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 after 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?
You can take steps to prevent patellar tracking disorder.
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
Health Tools help you make wise health decisions or take action to improve your health.
Actionsets are designed to help people take an active role in managing a health condition.
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
American Academy of Family Physicians (2010).
Patellofemoral pain syndrome. Available online:
American Academy of Podiatric Sports Medicine (2004).
Patellofemoral Dysfunction. Available online:
Callaghan MJ, Selfe J (2012). Patellar taping for patellofemoral pain syndrome in adults. Cochrane Database of Systematic Reviews (4).
Earl JE, Vetter CS (2007). Patellofemoral pain.
Physical Medicine and Rehabilitation Clinics of North America, 18(2007): 439–458.
Grudziak JS, Musahl V (2007). The youth athlete. In PJ McMahon, ed.,
Current Diagnosis and Treatment in Sports Medicine, pp.
194–256. New York: McGraw-Hill.
Hudgins T (2008). Patellofemoral syndrome. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation, 2nd ed., pp. 371–374. Philadelphia: Saunders Elsevier.
Kaplan L, et al. (2007). Patellar maltracking section
of Knee injuries. In PJ McMahon, ed., Current Diagnosis and Treatment in Sports Medicine, pp. 92–95. New York:
Rauh MA, Parker RD (2010). Patellar and quadriceps tendinopathies and ruptures. In JC DeLee et al., eds., DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice, 3rd ed., vol. 2, pp. 1513–1525. Philadelphia: Saunders Elsevier.
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
How this information was developed to help you make better health decisions.