Lateral patellar maltracking
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:
-
Lateral patellar mobilisations and soft tissue release through VL and TFL/ITB first
-
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.
-
For the tendinopathy component I'm planning early isometric quad loading and Spanish squats before progressing to closed chain work
-
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