Patellofemoral tracking syndrome, or patellar tracking disorder for short, is a type of patellofemoral pain common amongst athletes. In this post, we’ll share what patellar tracking disorder is, common symptoms, ways to potentially avoid it, and treatment options. 

Studies and the Orthopedic Review

Molly Vora, Emily Curry, Amanda Chipman, Elizabeth Matzkin, and Xinning Li contributed to the review Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology, and treatment options. It was published in 2017 referencing over 80 different studies on patellofemoral pain.

Source: Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology, and treatment options.

What is Patellar Tracking Disorder?

patellofemoral joint diagram showing the different parts of the knee

Image from BetterPT

The patellofemoral joint is where the patella meets the femur at the front of your knee. It’s a complex structure that involves bones and a network of muscles and connective tissues! The bones inside the patellofemoral joint are covered with articular cartilage that helps the bones glide smoothly against each other during movement. The patella is the largest sesamoid bone (bone embedded in tendons or muscles) in the body and is relatively flat and round. The area underneath your patella (kneecap) is called the patellofemoral groove. This grove allows your patella to move up and down and allows for limited side-to-side movement. 

Patellofemoral pain syndrome (PFPS) is the name given to various conditions that lead to anterior knee pain, and patellar tracking disorder is another name for PFPS. Patellar tracking disorder is one of the most common causes of knee pain and is present in females disproportionately to males. Research has shown that women have significantly more hip and lower leg internal rotation with less peak torque to body mass for the quads and hamstrings. This could be the reason that females are more susceptible than males. Symptoms usually include pain around the patella that can hurt more during knee-flexion activities (such as running, squatting, or walking up and down stairs). 

What Causes Patellar Tracking Disorder?

There are several reasons that patellar tracking disorder can occur, and usually, a combination of factors leads to injury. Here are the most common:

  • Overuse injuries where the knee is often extended, especially in high-impact sports (soccer, lacrosse, running, and others)
  • Patellar instability, where the patella moves outside of the groove
  • Malalignment of the lower extremity
    • Bow-legged (varus): a condition where a person’s legs appear “bowed out,” meaning that the knees stay wide apart even when the feet are close together. When the legs are shaped in this way, the weight passes through the inside (medial) part of the knee.
    • Knock-kneed (valgus): This is a condition where the knees are abnormally close together and the ankles are spread widely apart. It occurs when someone’s body weight passes through the outside (lateral) portion of the knee.
  • Flat feet, which can cause pain and medial cartilage damage
  • Muscular imbalance in the lower extremity, including weak quadriceps, lower abs, and hip muscles
  • Poor knee extension strength

image showing the difference between normal knees, knocked knees, and bow legged people

Image showing normal legs, bow leggedness, and knock knees from

What are Treatment Options for Patellar Tracking Disorder?

The good news is that most treatments for patellar tracking disorder are conservative. Surgical interventions are much less common. Key components in non-surgical treatment involve increasing strength and flexibility.

Clinicians are still learning how to treat patellar tracking disorder. Some common non-surgical approaches that have been implemented are:

  • Receiving a physical therapy treatment plan including hip abduction and core muscle strengthening exercises.
  • Correcting of gait disorders using gait training
  • Avoiding overuses injuries and swapping sports to cycling, swimming, and elliptical training that are less impactful on the knees (at least while the knees are irritated prior to treatment)
  • Seeking treatment for flat feet through physical therapy and/or purchasing supportive devices like foot orthotics, foot or leg braces, and custom-made shoes
  • Following *exercise tips for bow-legged and knock-kneed individuals
  • Improving knee extension range of motion through exercises
  • Wearing a knee brace alone might provide some symptomatic relief, but studies have not found a benefit when bracing is used in addition to physical therapy
  • Taping has been shown to be beneficial in some studies; however, further research is needed 

After conservative treatments have been tried for at least 6-12 months, if an individual is still feeling pain due to patellar tracking disorder, they may choose to have surgical intervention. Lateral release surgery, medial patellofemoral ligament repair, or osteotomy may be recommended. 

Contact Idaho Sports Medicine Institute to begin a treatment plan for patellar tracking disorder today!

*Please always consult your physician before beginning any exercise program. This general information is not intended to diagnose any medical condition or to replace your healthcare professional. Consult with your healthcare professional to design an appropriate exercise prescription. If you experience any pain or difficulty with these exercises, stop and consult your healthcare provider.