Patellar Maltracking and Subluxation
Treatment
Stretching
- Tensor Fascia Latae (TFL)
- Iliotibial band (ITB)
- Vastus lateralis (VL)
- Hip flexors
- Hamstrings
- Isometric/concentric/eccentric activation of the VMO
- Neuromuscular Stimulation (NMS) of the VMO
- Foam rolling (TFL, ITB, VL, hip flexors, hamstrings and gastrocnemius)
- Soft tissue mobilizations (STM) to TFL, ITB, VL
- Medial and inferior glides and tilts
- TFL
- ITB
- VL
- Hamstrings
- Torsional Osteotomy
- Lateral Release (Arendt et al 2002, Frosch et al 2011, Palmer et al 2004)
- VMO tendon advancement (Arendt, Palmer et al 2004)
- Modified tibial tubercle osteotomy (Arendt, Frosch et al 2011, Palmer et al 2004)
Prevention
Prevention will depend on the individual predisposition of anatomical structures along with appropriate structures to strengthen or lengthen focused in the treatment section. It is imperative to minimize tracking and pain evident of the physical activity performed. For maintenance and preventing further maltracking, taping methods and bracing can be utilized.
Knee brace (specific for patellar lateral maltracking)
Taping techniques preventing lateral tracking
Knee brace (specific for patellar lateral maltracking)
Taping techniques preventing lateral tracking
- McConnell taping
- Kinesiotaping
Education
- Limit or prevent physical activity causing pain and excessive lateral maltracking
- Maintain proper length-tension relationships
References
Andrish J. The management of recurrent patellar dislocation. Orthop Clin North Am 2008; 39(3): 313-327.
Arendt EA, Fithian DC, Cohen E. Current concepts in lateral patella dislocation. Clin Sports Med 2002; 21(3): 499-519.
Draper CE, Besier TF, Fredercison M et al. Differences in patellofemoral kinematics between weight-bearing and non-weight-bearing conditions in patient with patellofemoral pain. J Orthop Res 2011; 29:312–317.
Fithian DC, Paxton EW, Stone ML, et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32(5): 1114-1121.
Frosch S, Balcarek P, Walde TA et al. The treatment of patellar dislocation: a systematic review. Z Orthop Unfall 2011 Dec; 1249(6):630-45.
Greiwe RM, Saifi C, Ahmad CS, Gardner TR. Anatomy and biomechanics of patellar instability. Oper Tech Sports Med 2010; 18(2): 62-67.
Koeter S, Diks MJF, Anderson PG, et al. A modified tibial tubercle osteotomy for patellar maltracking: Results at two years. J Bone Joint Surg Br February 2007; 89-B:180-185.
Pal S, Draper CE, Fredericson M et al. Patellar maltracking correlates with vastus medialis delay in patellofemoral pain patients. Am J Sports Med 2011; 39:590
Sheehan FT, Derasari A, Fine KM, Brindle TJ, Alter KE. Understanding patellofemoral pain with maltracking in the presence of joint laxity: Complete 3D in vivo patellofemoral and tiobiofemoral kinematics. J Orthop Res 2009; 27:561–570.
Arendt EA, Fithian DC, Cohen E. Current concepts in lateral patella dislocation. Clin Sports Med 2002; 21(3): 499-519.
Draper CE, Besier TF, Fredercison M et al. Differences in patellofemoral kinematics between weight-bearing and non-weight-bearing conditions in patient with patellofemoral pain. J Orthop Res 2011; 29:312–317.
Fithian DC, Paxton EW, Stone ML, et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32(5): 1114-1121.
Frosch S, Balcarek P, Walde TA et al. The treatment of patellar dislocation: a systematic review. Z Orthop Unfall 2011 Dec; 1249(6):630-45.
Greiwe RM, Saifi C, Ahmad CS, Gardner TR. Anatomy and biomechanics of patellar instability. Oper Tech Sports Med 2010; 18(2): 62-67.
Koeter S, Diks MJF, Anderson PG, et al. A modified tibial tubercle osteotomy for patellar maltracking: Results at two years. J Bone Joint Surg Br February 2007; 89-B:180-185.
Pal S, Draper CE, Fredericson M et al. Patellar maltracking correlates with vastus medialis delay in patellofemoral pain patients. Am J Sports Med 2011; 39:590
Sheehan FT, Derasari A, Fine KM, Brindle TJ, Alter KE. Understanding patellofemoral pain with maltracking in the presence of joint laxity: Complete 3D in vivo patellofemoral and tiobiofemoral kinematics. J Orthop Res 2009; 27:561–570.