The patella is positioned at the center of the knee within a concave groove of the distal femur called the trochlea. With flexion and extension of the knee, the patella is designed to glide within the trochlea groove and remain centered. Patella malalignment is a condition where the patella does not centrally align within the trochlea. This is often present as a result of congenital malalignment but can also develop or be made symptomatic by associated muscle imbalances which can develop over time. Symptoms related to patella malalignment include anterior knee pain, intermittent knee swelling, knee crackling, knee buckling and occasionally patella dislocation.