The word 'mal' means 'bad' or 'poor'. Alignment can refer to the relationship of one bone to its neighbouring bone. The term 'malalignment' therefore means that the relationship or geometry of one bone in relation to its neighbouring bone is outside of what one might consider normal.
The term can be used for any bones, but in the knee it most commonly refers to the relationship of the patella (kneecap) to the underlying femur (thighbone), where abnormal forces through the patella tends to pull it over to maybe the side or to tilt it over in one or other plane.
A person with true (as opposed to 'functional') malalignment may be born with anatomical problems such as flat feet, knock knees, a poorly positioned tibial-tubercle (the bump below the knee to which the patellar tendon attaches) or abnormallity of the troclea (the groove in which the patella slides). Or the anatomy may have been normal but then an injury may have affected the situation, leading to instability of the patella which may then appear malaligned.
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