Lateral patella tilt
A 42-year-old woman presents with a few months of right knee pain. The pain is worse when going up and down stairs. She also complains of start-up knee pain after sitting for a long period of time. On examination, she has anterior knee pain over the lateral patellofemoral facet joint. She is noted to have lateral patella tilt on sunrise view radiograph (Figure 1). Which choice below does not contribute to lateral tilt of the patella?
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Patellofemoral pain is a common complaint associated with many ADLs, including sitting, going up and down stairs, kneeling, and squatting. The most common cause of patellofemoral pain is lateral patella maltracking. Lateral maltracking may be due to several etiologies, including vastus medialis weakness, hamstring tightness, lateral retinacula tightness, iliotibial band tightness, lower extremity malalignment, and trauma.
The vastus medialis oblique (VMO) helps keep the patella medial in the femoral trochlea during knee motion. A weak VMO can cause lateral maltracking. Tight hamstrings increase knee flexion and may prevent terminal extension during gait. This puts more strain and lateral force on the patella. Hamstring stretching and VMO strengthening are the primary focus of physical therapy for rehabbing lateral patella femoral compression syndrome. Lateral retinacula tightness can also pull the patella laterally, which can contribute to maltracking. Lateral retinacula release was a common surgical procedure performed in years past, but recent data show this to be ineffective for addressing patella femoral pain. Lower extremity deformities causing lateral maltracking of the patella include increased Q ankle, genu valgum, external tibial torsion, and excessive foot pronation. Trauma such as a patella dislocation can tear the medial supporting structures to the patella, including the medial patella femoral ligament (MPFL), which often results in chronic lateral patella instability.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
- Doucette SA, Goble EM. The effect of exercise on patellar tracking for lateral patellar compression syndrome. Am J Sports Med. 1992;24:434-440.
- Larsen B, Andreason E. Patellar taping: a radiographic examination of the medial glide technique. Am J Sports Med. 1995;23;465-471.