Miserable Malalignment Syndrome

Miserable Malalignment Syndrome

Miserable Malalignment Syndrome is a term used to describe a set of anatomical changes to the legs that cause knee pain and instability. The most common change being the internal rotation of the femur (thigh bone), this rotation usually occurs at the distal end where the femur forms the knee joint. Secondly is an inward facing patella (kneecap), which is referred to as a “winking patella”.   The lower leg (tibia and fibula) rotate outward and then the feet are flat.

Dramatic changes like these affect the position, movement and function of the knee joint drastically. Pain and discomfort is commonplace with this condition as well as putting the person at great risk for ongoing patellar joint dislocation and increased risk of arthritic change to the joint. This misalignment creates uneven pressures on the knee joint causing damage to the underlying articulate cartilage. This condition can occur in one or both knees.


Miserable Malalignment Syndrome is most commonly experienced among runners, but also occurs to bicyclists, basketball and volleyball players. Contact sports such as football and rugby also put athletes at risk for developing Miserable Malalignment syndrome. Repetitive exercises like lunges and squats put athletes at risk for the condition also.

It can be caused by an injury to the knee joint and then develop afterwards as result of the injury. Injuries such as meniscus tears or patella tendonitis may leave the longer lasting result of Miserable Malalignment Syndrome after the injury has healed. Degeneration of the patella from causes such as osteoarthritis and Chondromalacia patellae may also result in Miserable Malalignment Syndrome.


Symptoms of Miserable Malalignment Syndrome include;

  • Anterior knee pain
  • Pain under the patella
  • Stiffness of the knee joint
  • Progressive aching or grating pain
  • Excessive grinding, popping, and clicking sounds on knee flexion
  • Knee joint giving out painfully
  • Knee doesn”t lock or catch

These symptoms may be aggravated by going up and down stairs, running, excessive squatting, or sitting with the knees bent for prolonged periods of time. Other signs of the condition are excessive pronation while running, no knee effusion, abnormal patellar alignment and tracking, increased Q angle of the knee, and tenderness of the knee joint.


While signs and symptoms may make it probable that one is suffering from Miserable Malalignment Syndrome, the only way to be certain is to have it examined by an orthopedic physician. X-rays will determine if this is indeed the case.


Treatment of the injury at first may be as simple as ice therapy and NSAID”s to control the swelling and inflammation of the knee joint. Rest therapy is also utilized. Limiting use by restricting running, walking, squatting, lunging, and monitored exercise utilizing swimming, biking or an elliptical trainer is also common therapy for Miserable Malalignment Syndrome.

Lower extremity exercises for improving leg strength and stretching as well as isometric resistance exercises are also used for therapy for the condition. Use of a knee brace may be recommended during exercise.

For advanced cases of Miserable Malalignment Syndrome that simple exercise therapy doesn”t help, surgery may be required to correct the condition, but this is usually only necessary in less than %10 of the cases.

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  1. julijana cvitanovic Reply

    Please l need help two years l have problem and left knee is operated twice it is lteral meniskus l fall down and l am not sure there is hondromaltia or malaligment patele.julijana cvitanovic

  2. Lesley Farage Reply

    Can you recommend exercises for mis/mal. I had a car accident 7 years ago . Since then I experience most of the symptoms mentioned in the report.

  3. katia xavier-gelman Reply

    My daughter, who is sixteen, has been just diagnosed with MMS. She has already had 3 surgeries, by two different doctors, on her knees. Although this diagnosis finally makes sense, I am cautious about the surgery to correct it. I am writing to ask if you know of any specialist in South Florida, as that is where we live. Any help would be greatly appreciated. Thank you in advance.

    Katia Xavier-Gelman

    1. Dianna Fuller

      Hi Katia. My daughter also has MMS. She was diagnosed at age 13. Dr. Dror Paley at St. Marys Medical Center in WPB is a world renowned surgeon. A miracle worker. She is doing very well and looking forward to a bright future.

  4. Joan Knoll Reply

    Hi- my daughter who is 14 was diagnosed with miserable misalignment in her knees. Is there a good surgeon in North Dakota in the Fargo area or someone who is an expert on this health issue.
    Joan Knoll

  5. Emily Wyatt Reply

    I have this patella tilts, Tibet and fib are misaligned. Knee been giving grief for years. Tore medical meniscus 4 yrs ago, opted not o have an arthroscopy due to it increasing the chance of arthritis. Ironically I have severe loss of joint space. Going back to orthopaedics. Ligaments affected also. The name is very apt as it is miserable physically and emotionally.

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