T Nation

Patellar Malalignment Question?


First I will start out with some background info.

I have had knee pain pretty much as long as I can remember since I was probably about 10 (so 16 years).

I remember when I was young I was diagnosed with patellar malalignment which causes my knees to track improperly. I never had surgery to correct it and it seems to have gotten worse.

Currently, I can't play any sports without having pain and soreness for multiple days. Some days I am able to squat without pain, but many days it prevents squatting. It is also painful on lunges.

Is this something I can rehabilitate without surgery (or at least strenthen some muscles enough to mask the structural problem), or do I need to bite the bullet and have it operated on?

If it is something I can improve without surgery, I would definitely like some advice as far as a good rehab workout, stretches, etc.




I have a similar condition, and I ice the knees regularly, especially after a workout or after longer bicycling trips. On some days, I ice both knees 3 times a day for 10 minutes.

Strengthening the muscless and tendons around the knee seemed to help. I did that by lifting the weight with both legs in the leg extension machine,
holding the weight with only 1 leg for a few seconds, then lowering it with the same leg.

The standard advice is to strenghten the vastus medialis (teardrop muscle), but I haven't found any specific exercises to do this.

I wouldn't recommend lunges. In my case they made it worse, my knees simply couldn't handle the instability and I partly ruptured the tendon below my right kneecap. Perhaps I'm just a clumsy dufus. Correct that: I am a clumsy dufus. Stil nurtering that tendontear though, but the docter is about to give me the green light on quad exercises in a couple of weeks. I hope.


i can tell you my expereinces, btw im aobut twice youre age, so just more years on the knees.

anyway the only rehab/strength program that anyone ever suggested to me was to do isometrics to the opposite side that your patella tracks to. in so doing, (the thought goes) you train the muscle to pull the patella into more correct allinment.
i didnt have much luck with it.

i have had lateral releases on both knees as well as other scope procedurs as well.
my patellas dont dislocate anymore but i still have constant minor pain. of course if i do squats, deads or walk-run on the treadmill, i have bitchen pain.
i take glucosimine and chondroiten, 5 caps a day as well as fish or flax oil 10/day. this helps some.
what i find helps the most is a HOT epsom salt bath afte a work out and cool down. I have just started doing this and i am pain free the next day.
i also unse ice and massage.
best of luck to you.


Although I'm no expert I do have a bit of personal experience with knee problems, especially patella tracking problems.

One thing that I've found useful is to work on your VMO (the tear-drop part of your quad on the medial side of your knee). The VMO assists in full extension and also stabilises the patella. Even if you have significant musculature in this area it may not be 'firing' correctly. Subsequently, your patella can be tracked laterally, causing discomfort.

I have found the following to be useful: Perform squats against a wall with a swiss ball behind your back and your feet out in front. Do this with a soccer/basketball or medicine ball between your knees. Squeeze the ball hard and fully extend the knees at the top of the squat, really concentrating on the VMO. Also, light-single leg extensions, focusing on just the last 30 degrees of extension, both with your feet neutral and externally rotated (toes out). Finally, stretch those ITBs, Hammies and glutes.

Hope this helps.


Thanks for all of the advice. I plan to try the wall squats tonight.

I am also leaning towards going back to the doctor for it and see what is suggested as of now.


i have had the realignment surgery. im sure there are cases that are more severe than others so ill just explain my experience. the first time i had a problem was 7th grade performing the "long jump" in gym class. i guess i came down more on my left foot and my knee just buckled out. it was a ridiculous amount of pain and the doctor told me that i tore a ligament. i was in a knee mobilizer for a while and that was that. during 8th grade i must have blown my knee out at least every other month.

however, since i thought i knee what was going on, i would roll around on the ground for a minute, long enough to calm myself down and slowly stretch my leg back out and then get myself off the ground. then i started wearing a cheap, but effective, ace knee wrap i got at k-mart whenever i had gym class or played sports. in high school i played hockey, and every so often making sharp turns and such my knee would just go out and id slide across the ice until something, usually the boards, stopped me.

during my junior year, being a drunken idiot at my friends house i jumped over a couch and that was about all she wrote for my knee. up until this point, when my knee went out it would be swollen, and gradually get stronger over a few days until it was back to at least being stable. this time it took a bit longer, i sucked on the ice for probably a week+ and at that point i went to the doctors. he told me i needed surgery to realign the knee cap as well as arthroscopic surgery to clean out all the scar tissue, because i had at some point or another, torn just about everything in there at least once. luckily, the season was over soon so i decided to wait a little bit.

anyway, i had the surgery, which for me meant cutting off the tip of one of the shin bones and screwing it back in about 1/4 inch over. he also scoped three spots. my knee has not gone out since. it definitely took a long time to build back any type of strength though. every now and then if i step on an unever surface or something it feels like it did just before the point where it would buckle and id be on the ground, but it never goes past that point, and im not sure if it will, because either way its a quick little jolt telling me to stop doing whatever im doing real quick.

also, the tip of the bone that has screws in it used to get pretty sore, i think because the tendon wasnt used to stretching to its new position or something, but that went away and the "bad" knee is virtually the same as the "good" one. it was also a pain in the ass doing squats and leg presses and such for a while because the "good" leg would do much more of the work and on leg day and the days after it felt ridiculous.

definitely go back to the doc and get the thing x-rayed. its not as bad of a surgery as its made out to be. first day or so after was very uncomfortable but after that its fine. also the doc told me 2-3 months of crutches, but i went to one crutch a day or so after and no crutches 4 days after the surgery. good luck