Knee Pain, Anterior/Patellofemoral Malalignment Syndrome



  • 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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