Patellar malalignment is present when the kneecap is not sitting in the optimal position.
Causes of patellar malalignment
Causes may be local (such as patella alta, patellar tilt, patella baja, dysplasia of patella or trochlea, or an abnormally-positioned tibial tubercle) or related to abnormal rotations at the hip or femur. So it is an observation, rather than a diagnosis, and the diagnosis needs to be sought via investigation.
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CLINICAL PUBLICATIONS
The Operative Management of Patella Malalignment. Iliadis AD, Jaiswal PK, Khan W and Johnstone D. Open Orthop J. 2012; 6: 327–339.