One must also address the patellofemoral joint. Many patients with knee pain have a patella that is maligned or maltracking. A maltracking patella is usually caused by tight lateral structures including the lateral retinaculum and iliotibial band and atrophy of the vastus medialis oblique. These problems cause the patella to sit incongruently and tilted and when the quadriceps contracts the patella is pulled laterally. We have a very specific program of rehabilitation for patients with patella maltracking that involves manually stretching tight lateral structures, taping of the patella and graded closed chain quadriceps exercise. The use of biofeedback is employed to help the patient actively recruit more of the vastus medialis oblique. Most patients with patellofemoral pain and maltracking respond very well to our program.
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