Quick Summary
Patellar tracking problems and patellar instability share overlapping symptoms but differ in cause and management. Tracking issues often stem from muscle imbalance and respond to physical therapy, while true instability — recurrent dislocations or subluxations — usually involves anatomic factors like trochlear dysplasia and a torn MPFL. Imaging-based measurements (TT-TG, Caton-Deschamps index, trochlear morphology) help distinguish the two and guide whether rehab or surgery is appropriate.
In this episode of the Brawn Body Health and Fitness Podcast, I joined Dan to discuss patellar tracking and patellar instability in detail, including surgical management such as MPFL procedures and osteotomy procedures.
Listen to the podcast to learn more about our discussion of patellar tracking abnormalities and patellar instability.
Patellar tracking refers to how the kneecap glides through the trochlear groove during knee motion — it can be off-center without ever dislocating. Patellar instability means the kneecap actually dislocates or subluxates partially. Tracking issues often respond to physical therapy targeting the quadriceps, hips, and core, while recurrent instability typically requires evaluation for surgical reconstruction.
Plain radiographs assess patellar height (Caton-Deschamps or Insall-Salvati index) and overall alignment. CT or MRI measures the tibial tubercle to trochlear groove (TT-TG) distance and trochlear dysplasia grade. MRI also evaluates the MPFL, cartilage, and any loose osteochondral fragments. Together these define the anatomic risk profile and guide treatment.
Physical therapy is the first-line treatment for first-time dislocations and for tracking issues without recurrent dislocation. It works well when anatomy is favorable. When the patient has multiple dislocations, significant trochlear dysplasia, or patella alta, rehab alone usually cannot prevent recurrence — surgical reconstruction provides more reliable stability in those cases.
Dr. Sabrina Strickland sees patients at Hospital for Special Surgery in New York City. If you would like a personalized evaluation of your symptoms and options, request a consultation below.
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