From the Guidelines
A tilted kneecap, medically known as patellar tilt, is a condition where the kneecap (patella) is not properly aligned within the groove of the thigh bone (femur), and the best practice for managing related patellofemoral pain involves delivering knee-targeted exercise therapy, with supportive interventions as required, as recommended by a recent study published in the British Journal of Sports Medicine 1.
Definition and Causes
A tilted kneecap is characterized by the misalignment of the kneecap, causing the outer edge to tilt upward and the inner edge to tilt downward. This condition often occurs alongside patellar tracking disorder, where the kneecap moves abnormally when the knee bends and straightens. The primary causes include muscle imbalances, with the outer thigh muscles (vastus lateralis) being stronger or tighter than the inner thigh muscles (vastus medialis), as well as other factors such as flat feet, weak hip muscles, tight hamstrings, or structural abnormalities in the knee joint.
Symptoms
Symptoms of a tilted kneecap include pain around or behind the kneecap, especially when climbing stairs, squatting, or sitting for long periods. Patients may also experience a feeling of the knee giving way and occasional swelling or stiffness.
Treatment
Treatment for a tilted kneecap typically involves physical therapy to strengthen the inner thigh and hip muscles, stretching tight muscles, using proper footwear or orthotics, and in some cases, using a knee brace temporarily. According to the best practice guide for patellofemoral pain, education should underpin all interventions, adjusted to reflect the needs of the person 1. Surgery is rarely needed unless there are severe structural issues or the condition doesn't respond to conservative treatment.
Management Approach
The management approach should prioritize knee-targeted exercise therapy, with supportive interventions as required, as this approach has been shown to be effective in managing patellofemoral pain, as indicated by a study published in 2024 1. This study emphasizes the importance of synthesizing multiple data streams, including data from randomized controlled trials and interviews with patients and clinical experts, to inform best practices for patellofemoral pain management.
From the Research
Definition of a Tilted Kneecap
A tilted kneecap, also known as patellar tilt, refers to an abnormal alignment of the kneecap (patella) in relation to the surrounding bones and soft tissues.
- This condition can be associated with patellofemoral pain syndrome (PFPS), a common knee disorder that accounts for 25 to 40% of all knee disorders 2.
- Studies have investigated the relationship between patellar tilt and PFPS, with some findings suggesting that lateral patellar tilt may be a predictor of PFPS, although the evidence is inconsistent 2, 3.
Physical Examination and Diagnosis
Physical examination maneuvers are often used to diagnose PFPS and assess patellar tilt, including:
- Q angle measurement
- Crepitus (grinding or crunching sensation in the knee joint)
- Strength and functional testing
- Patellar tilt or mediolateral displacement
- Decreased flexibility of the iliotibial band and quadriceps
- Quadriceps, hip abductor, and external rotator weakness 2, 3.
- However, the reliability of these physical examination tests alone is generally low, and clustering physical examination findings may provide better sensitivities and specificities in diagnosing PFPS 2.