Patellar Malalignment Specialist

Are you experiencing significant knee pain on the outside of your knee?  Do you have difficulty climbing stairs or experience knee pain when sitting for prolonged periods of time?  If so, you may have a knee condition called Patellar Malalignment. Patellar malalignment commonly affects athletes and active individuals and is often felt with activities like skiing or running. Patellar malalignment and patellar entrapment specialist Doctor Riley J. Williams provides diagnosis as well as surgical and nonsurgical treatment options for patients in Manhattan, Brooklyn, New York City and surrounding areas who are experiencing symptoms of patellar malalignment and entrapment. Contact Dr. Williams’ team today!

What is patellar malalignment?

Patellar malalignment is a syndrome or condition that causes pain in the front of the knee or patella (kneecap). The pain commonly affects athletes and active individuals; the pain is associated with activities such as running and skiing. Patellar malalignment is characterized by poor patellofemoral tracking. This disorder results in excessive pressure on the surfaces of the kneecap as the patella moves out of its normal alignment in the femoral groove (trochlea). The kneecap sits in a groove within the femur called the patellofemoral groove or trochlea; the trochlea facilitates normal lengthwise (vertically, up and down) movement of patella. The patella can also move within this groove slightly from side to side and can tilt or rotate while remaining secure on the knee. The natural contour of the trochlea keeps the kneecap in place during normal and athletic activities. The patellofemoral joint is where the patella (kneecap) and femur (thighbone) connect at the front of the knee. When leg muscle imbalances lead to poor patellofemoral tracking and malalignment, individuals can experience significant anterior knee pain. This condition is more common in women.


Patellar Malalignment

What is patellar entrapment?

Patellar is a different clinical entity compared to patellar malalignment. Patellar entrapment occurs when there is a buildup of scar tissue around the patella.  The build up of scar tissue results in a a decrease of patellar mobility. This decreased patellar mobility results in high pressures on the kneecap cartilage, and oftentimes increased anterior knee pain and dysfunction. . Patellar entrapment will restrict the ability of the knee to extend and flex, limiting the range of motion of the patella. Patellar entrapment can occur following a knee trauma, knee ligament injury of following a knee surgery if appropriate rehabilitation protocols are not followed. Doctor. Riley J. Williams, orthopedic knee specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas has extensive experience in patellar malalignment, patellar entrapment other knee joint related conditions.

What are the symptoms of patellar malalignment?

Patellar malalignment has common symptoms shared by other knee injuries, sometimes making it difficult to diagnose the condition. Individuals in the New York area often report the following with patellar malalignment:

  • Significant anterior knee pain
  • Feeling that the knee may give out / knee giving way
  • Crepitus (crackling, crunching or popping)
  • Stiffness
  • Tenderness
  • Trouble climbing stairs
  • Pain with extended periods of sitting

How is patellar malalignment diagnosed?

Dr. Williams will perform a physical examination that may include inspecting foot abnormalities and gait. Dr. Williams will also monitor your ability to extend your knee while in a seated position, checking for placement of the patella during knee extension as well as pain. He may apply hands-on pressure to the patella to check for placement. If tissue damage is suspected, an MRI scan may be ordered to rule out tendon, cartilage, or bone damage.

How is patellar entrapment diagnosed?

Dr. Williams will perform a physical examination that may include inspection of the knee joint and patella. He will check your knee range of motion and mobility of the knee cap. He will do test to check the alignment of the patella. If scar tissue formation is suspected around the patella, he will order radiographs, and an MRI to assess the soft tissues around the kneecap.

What are the treatment options available for patellar malalignment and patellar entrapment?

Non-surgical treatment:

Non-surgical treatment may include physical therapy to strengthen the areas that have an effect on knee pain such as hip rotation, quadriceps, and hamstring exercises. A brace to realign the patella may also ease pain. NSAIDs (non-steroidal anti-inflammatories) can help alleviate pain and swelling during flare ups. If patellar mobility is limited, PT may be used to help increase kneecap motion.

Surgical treatment:

Proximal or distal realignment surgery may be required for patellar malalignment. Proximal re-alignment surgery involves either lengthening structures that limit the movement on the outside of the patella or shortening ligaments on the inside of the patella.

Distal re-alignment surgery involves moving the tibial tubercle (the insertion site of the patellar tendon on the tibia) toward the inner side of the knee. This re-alignment procedure is very effective in restoring normal knee mechanics. This procedure can decrease kneecap joint forces and restore stability. The quadricep angle, known as the Q-angle, is the measurement of the knee between the quadriceps muscles and the patellar tendon. Distal re-alignment surgery restores the Q-angle to a more normal value. The angle is commonly different between women and men, which is another factor of why patellar malalignment occurs more often in women.

In cases of patellar entrapment, arthroscopy or open surgery may be necessary to remove scar tissue and to increase patellar mobility. Soft tissue release may also be used to restore normal patellofemoral mechanics.

After surgery, you will be required to rest, and then the use of crutches will be necessary for 1-2 weeks. Physical therapy is typically needed for 2-3 months after such procedures.

For more information on patellar malalignment and patellar entrapment and the treatment options available, please contact the office of Riley Williams, MD, orthopedic knee specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas.


HSS Sports Medicine Institute West Side
610 W 58th Street
New York, NY 10019

HSS Brooklyn
148 39th Street, 7th Floor
Brooklyn, NY 11232

Office Hours

Monday-Friday: 9:00 am – 4:30 pm
Fax: 212-774-2895