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Knee Pain, Anterior/Patellofemoral Malalignment Syndrome

Knee Pain, Anterior/Patellofemoral Malalignment Syndrome is a topic covered in the 5-Minute Pediatric Consult.

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  • Condition characterized by discomfort at the anterior aspect of the knee that is generally associated with activities, especially those that involve running, jumping, and climbing stairs
  • Has also been called “miserable malalignment syndrome”


  • Predisposing factors for patellofemoral malalignment syndrome include the following:
    • Femoral anteversion
    • Genu valgus
    • Pes planus
  • These three anatomic features have been commonly referred to as a terrible triad contributing to anterior knee pain. Because the entire kinetic chain is linked in function, malalignment at one area can lead to secondary stresses at a distant location.
  • Excess femoral anteversion, as well as marked pes planus, can contribute to increased lateral pull on the patella and subsequent patellofemoral pain.
  • Further contributing factors include a wider pelvis and a more laterally positioned tibial tubercle, both of which also contribute to altered biomechanics at the knee.
  • Weak hip abductors and quadriceps muscles and tight hamstrings, iliotibial band, Achilles tendons, and quadriceps can lead to increased forces across the patellofemoral joint.

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Cabana, Michael D., editor. "Knee Pain, Anterior/Patellofemoral Malalignment Syndrome." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618160/all/Knee_Pain__Anterior_Patellofemoral_Malalignment_Syndrome.
Knee Pain, Anterior/Patellofemoral Malalignment Syndrome. In: Cabana MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618160/all/Knee_Pain__Anterior_Patellofemoral_Malalignment_Syndrome. Accessed April 24, 2019.
Knee Pain, Anterior/Patellofemoral Malalignment Syndrome. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618160/all/Knee_Pain__Anterior_Patellofemoral_Malalignment_Syndrome
Knee Pain, Anterior/Patellofemoral Malalignment Syndrome [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618160/all/Knee_Pain__Anterior_Patellofemoral_Malalignment_Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Knee Pain, Anterior/Patellofemoral Malalignment Syndrome ID - 618160 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618160/all/Knee_Pain__Anterior_Patellofemoral_Malalignment_Syndrome PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -