Maltracking refers to a patella which is not tracking smoothly in the groove of the underlying femur during normal knee movement. Page updated July 2024 by Dr Sheila Strover (Clinical Editor)
Structural abnormalities in the upper part of the groove make the mechanism particularly liable to dislocation.
The patella is like a pulley, attached below to the tibia via the patellar tendon and above to the femur and hip via the quads tendon and muscle and tracking in the groove of the femur with end motion of the knee.
There may be structural bony reasons for this, or the muscles controlling movement may simply be out of balance. At the upper end of the groove, even under normal circumstances, there is very little contact between the undersurface of the patella and the groove, and the walls of the groove are flatter here, so any change affecting this region may allow the patella to slip up and over the walls of the groove.
Peer-reviewed papersQuote from peer-reviewed paper:
Citation: Jibri Z, Jamieson P, Rakhra KS, Sampaio ML, Dervin G. Patellar maltracking: an update on the diagnosis and treatment strategies. Insights Imaging. 2019 Jun 14;10(1):65. doi: 10.1186/s13244-019-0755-1. PMID: 31201575; PMCID: PMC6570735.
Maltracking is a disturbance of this relationship and results in pain at the front of the knee, and the patient may have a history of frequent 'giving way', 'subluxation' and even a past 'dislocation' of the kneecap. The doctor will assess how lax the patella is in the groove, perform the patellar tilt test. The patient may actively block any attempt at performing the patellar apprehension test.
Quick linksAppropriate imaging may identify risk factors, as well as any structural damage that has already occurred secondary to past dislocations, such as joint cartilage damage, bony damage and ligament damage.
In terms of risk factors, the practitioners will be assessing:
A do-nut brace may offer local support. If surgery is necessary, it may be a matter of repairing torn ligaments (especially the MPFL ligament), adjusting the tension of other fibrous structures supporting the patella on the sides, and repositioning the patella via proximal and distal realignment procedures.
Peer-reviewed papersQuote from peer-reviewed paper:
Citation: Jibri Z, Jamieson P, Rakhra KS, Sampaio ML, Dervin G. Patellar maltracking: an update on the diagnosis and treatment strategies. Insights Imaging. 2019 Jun 14;10(1):65. doi: 10.1186/s13244-019-0755-1. PMID: 31201575; PMCID: PMC6570735.
Teasing out some of the issues with patellofemoral pain from maltracking.