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Patellar mal-tracking,

The patello-femoral (PFJ) joint is a relatively unstable and highly mobile joint. The kneecap sits in a wide “V” shaped channel and it glides up and down in this channel as the knee bends and straightens. If the patella does not sit accurately in its groove, pressure is not distributed equally across the patella and results in pain. There are many reasons why this may occur, but in most instances, it is related to the way people are built.

There are specific situations where an injury around or adjacent to the knee joint can affect the tracking of the patella and cause anterior knee pain as a side-effe ct.

Once again, it is probably advisable to try conservative means such as physiotherapy and orthotics before embarking on surgical correction.

If surgery is contemplated, then a full three-dimensional assessment of the patellofemoral joint is required, usually a CT scan is employed to work out the exact position of the track of the patella relative to its normal position.

The surgical plan is then made which usually involves the strengthening of tissues on one side and release of tissues on the other to get the patella to sit properly in its groove. Almost invariably the kneecap will sit laterally or to the outside rather than medially (or to the inside of) the knee and most surgical operations are designed to correct this mal alignment.

Sometimes the patient has been unfortunate enough to have developed a very shallow groove and surgery to deepen the groove can be contemplated. Other options are to move the attachment of the patella tendon to a more medial or inside position that will cause the patella to move away from the lateral side and sit more comfortably in its normal midline position.

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