The history, physical examination, and x-rays must be assessed for the physician to have a good idea of the problem. He should be able to help the patient understand the problem and the potential for treatment. MRI is not necessary unless there is a question of ligament injury.
A good history should make the physician suspicious of a patellar problem even before examining the patient or the x-rays. When combined with a good examination and x-rays, the diagnosis should be fairly certain in most patients.
Even with a good evaluation, there are times when the diagnosis is still not clear. A patellar stabilizing brace can be very helpful both as a trial and as temporary treatment. If the patella is stabilized by the brace, the patient will probably be more comfortable. A brace will create lateral patellar pressure to center the patella in the femoral groove. This can help confirm the diagnosis.
Another option in questionable cases is the physical therapy technique of patellar taping described by Jenny McConnell, an Australian physical therapist. Tape temporarily holds the patella centered in the femoral groove. If there is a positive response to patellar taping, the diagnosis is usually confirmed.