Patellar Maltracking in HEDS

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Patellar maltracking is a common issue affecting many people with hypermobile Ehlers-Danlos Syndrome (hEDS). This condition can cause knee pain, instability, and difficulty with everyday activities. Understanding what patellar maltracking is, why it happens in hEDS, and how to manage it can help people improve their quality of life and reduce discomfort.

Patellar maltracking occurs when the kneecap (patella) does not move smoothly within the groove at the end of the thigh bone (femur) during knee movement. Instead of gliding straight up and down, the patella shifts sideways or tilts, causing uneven pressure on the joint. This misalignment can lead to pain, swelling, and damage to the cartilage under the kneecap.

In people without hypermobility issues, the ligaments and muscles around the knee keep the patella aligned. However, in those with hypermobile EDS, the connective tissues are more elastic and less stable, making it easier for the patella to slip out of place.

Hypermobile EDS is a genetic condition that affects collagen, a protein that provides strength and structure to connective tissues. When collagen is weaker or more elastic than usual, joints become loose and unstable. This joint laxity is a key factor in patellar maltracking for several reasons:

• Loose ligaments: The ligaments that hold the patella in place are stretched or weakened, reducing their ability to keep the kneecap aligned.

• Muscle imbalances: Weakness or poor coordination in the muscles around the knee, especially the quadriceps, can cause uneven forces on the patella.

• Joint hypermobility: Excessive joint movement increases the risk of the patella shifting out of its normal path.

• Structural differences: Some people with hEDS may have subtle differences in bone shape or alignment that contribute to maltracking.

  
  

Together, these factors create an environment where the patella can easily move off track, leading to pain and functional problems.

Recognizing patellar maltracking early can help prevent further damage. Common signs and symptoms include:

• Knee pain that worsens with activities like climbing stairs, squatting, or sitting for long periods

• A feeling of knee instability or the knee “giving way”

• Grinding or clicking sensations when bending or straightening the knee

• Visible or palpable shifting of the kneecap

• Swelling around the knee joint after activity

  
  

If you experience these symptoms and have hypermobile EDS, it is important to consult a healthcare professional familiar with connective tissue disorders.

Treatment focuses on improving knee stability, reducing pain, and preventing further damage. Here are some strategies that can help:

A tailored physical therapy program is often the first step. Key goals include:

• Strengthening the quadriceps, especially the vastus medialis obliquus (VMO) muscle, which helps pull the patella into proper alignment

• Improving hip and core strength to support overall lower limb alignment

• Enhancing proprioception (body awareness) to improve joint control

• Stretching tight muscles that may pull the patella off track

  
  

Exercises should be low-impact and avoid movements that cause pain or instability. Working with a physical therapist experienced in hypermobility can ensure exercises are safe and effective.

Supportive devices can help guide the patella and reduce symptoms:

• Patellar stabilizing braces provide external support to keep the kneecap aligned during activity.

• Kinesiology taping techniques can improve patellar tracking by gently pulling the kneecap into place.

  
  

These tools are often used alongside exercise therapy for better results.

Avoiding activities that cause pain or increase instability is important. For example:

• Limit deep knee bends or heavy squatting

• Use assistive devices like canes or crutches if needed during flare-ups

• Choose low-impact exercises such as swimming or cycling

  
  

Over-the-counter pain relievers may help control discomfort. In some cases, healthcare providers might recommend other treatments like corticosteroid injections or, rarely, surgery. Surgery is usually a last resort and considered only when conservative measures fail.

Managing patellar maltracking requires ongoing attention. Here are some practical tips:

• Listen to your body and avoid pushing through pain.

• Maintain a consistent exercise routine to keep muscles strong and joints stable.

• Work closely with healthcare providers who understand hypermobility.

• Use supportive footwear to improve overall alignment.

• Consider lifestyle changes that reduce joint stress, such as weight management.