Patellar malalignment is a general term pertaining to any abnormality of the position or tracking of the patella.
Malalignment is a very important diagnosis to make because malalignment of the kneecap and the surrounding tissues has the potential to cause pain and/or instability. It is a diagnosis that is frequently missed.
Now malalignment encompasses a number of conditions. If I am the patient and the surgeon says that I have malalignment then I would want to know exactly what he or she means by that term. If the surgeon says you have malalignment that means that he or she at least has some idea of what might be causing causing the pain.
The surgeon must feel that the patella is either tilted, meaning that the lateral side or the outside part is down, the other side is up - like a beret rather than a hat - or the surgeon thinks that there is an increased q-angle, which means that the tibial tuberosity is not positioned properly, and or the patella is riding too high in the groove . Or any combination thereof. So that is already a much more specific diagnosis than say ‘chondromalacia’.
So that in a nutshell would be the sequence. With the patient lying down obviously there are many other things to check for - the tilting of the kneecap and of course there are other things in the knee that need to be examined.