Lateral patellar maltracking

CLINICAL CONSULT

Hi, just wanted to get some input on a patient I've been managing with chronic PFPS, roughly 12 months duration now with limited progress.

Patient profile: Active male, onset from heavy trap bar deadlifts (high-handle variation significant quad dominance in his pulling pattern). On assessment I confirmed lateral patellar maltracking right knee

On assessment I confirmed lateral patellar maltracking right knee. Key findings:

- Positive lateral patellar tilt test, reduced medial glide

- Visually notable VL hypertrophy relative to VMO I think the quadriceps vector is being pulled laterally because of it

- Lateral retinacular tightness contributing to a tracking bias

- Reduced hip abductor strength and femoral internal rotation bias on single leg loading

Current presentation:

- Pain localised to the quadriceps tendon insertion at the superior pole. Sits more in quad tendinopathy territory than PFPS, and I think we may be dealing with both concurrently given the maltracking.

- Audible and palpable crepitus during active unloaded flexion-extension

- Mild persistent synovial inflammation

- Functionally unable to perform any quad-dominant lower body loading without aggravation

Here's the treatment plan I'm working with and where I'd love input:

  1. Lateral patellar mobilisations and soft tissue release through VL and TFL/ITB first

  2. McConnell taping in the early loading phases while motor control is being re-established transitioning to a patellar brace or dropping it entirely as closed chain control improves.

  3. For the tendinopathy component I'm planning early isometric quad loading and Spanish squats before progressing to closed chain work

  4. Hip abductor and glute strengthening from day one given the femoral IR findings - lateral band walks, single leg Romanian deadlifts, step downs to directly challenge the femoral IR pattern under load. Does this look decent? Anything you'd add/change here for a maltracking case?

Posted Mar 5, 2026, 11:48 AM UTC

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