Pain related to lateral patella malalignment and focal cartilage overload

It is interesting that many young people with chronic anterior knee pain have either lateral retinacular tightness, distal or lateral patella cartilage softening, or both. Coincidentally, when there is demonstrable lateral tightness and tilt of the patella coincident with lateral patella softening, lateral release often yields relief of pain as the lateral articular overload is diminished. I refer to this lateral tilt as rotational malalignment.

In my experience, there is a close connection between such rotational malalignment, lateral patella cartilage softening, and pain. Therefore, in properly selected patients, lateral release for correction of rotational malalignment is therapeutic.

John P. Fulkerson

In more advanced forms of this lateral overload condition, particularly when there is also lateral subluxation of the patella functionally, more advanced lateral and distal patella cartilage breakdown may occur. In such cases, lateral release may not be enough and anteromedial tibial tubercle transfer may be necessary to restore balanced tracking of the patella and relief of pain permanently.

John P. Fulkerson, MD, is a clinical professor of orthopedic surgery at the University of Connecticut School of Medicine and practices at Orthopedic Associates of Hartford in Farmington, Conn. He is also president of The Patellofemoral Foundation.

Disclosure: Fulkerson receives royalties from DJO Global and is a patent holder for DJO Global.