Chondromalacia Patella

Definition

Articular cartilage cushions the femur (thighbone) and tibia (shinbone) where they meet in the knee, allowing them to move freely and easily. Chondromalacia patella is a softening or wearing away of the articular cartilage on the undersurface of the patella (kneecap).
Chondromalacia of the Knee
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Causes

Chondromalacia patella is caused by repetitive motion and misalignment of the kneecap.This can occur due to:
  • Birth defect in knee alignment
  • Weak quadriceps
  • Muscle strength imbalance between the inside and outside of the thigh
  • Direct trauma

Risk Factors

Chondromalacia patella is more common in adolescence and young adulthood. Other factors that increase your risk of chondromalacia patella include:
  • Participation in activities like running, skiing, cycling, or soccer that put repeated pressure on the patellofemoral joint
  • Knock-knee abnormality of the leg

Symptoms

Symptoms may include
  • Acute or chronic knee pain that worsens slowly over time
  • A popping or cracking sound as the knee is flexed and extended
  • Increased pain when climbing stairs, squatting, kneeling, or running
  • Pain and stiffness in the knee after it is flexed for a long period of time

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Your knee may need to be viewed. This can be done with:

Treatment

Talk with your doctor about the best treatment plan for you. Options include:

Supportive Care

The knee will need time to heal. RICE is often the main part of treatment:
  • Rest—Activities may need to be restricted at first.
  • Ice—Ice therapy may help relieve swelling.
  • Compression—Compression bandages can provide gentle pressure to help move fluid out of the area.
  • Elevation—Keeping the affected area elevated can help fluids drain out or prevent fluids from building up.
Prescription or over-the-counter medications may be advised to reduce pain. Physical TherapyA physical therapist will assess the knee. An exercise program will be created to help recovery and to strengthen the muscles in the leg. SurgeryIn most cases, surgery is not needed. But surgery may be needed if other treatments are not helpful. Surgical procedures include the following:
  • Moving the quadriceps muscle insertion on the lower leg to improve alignment
  • Releasing the lateral thigh muscles and tightening the medial muscles
  • Smoothing over the undersurface of the patella
  • Implanting cartilage taken from one’s own knee

Prevention

To reduce your chances of chondromalacia patella, take these steps:
  • Maintain a healthy weight to reduce stress on your knees.
  • Properly warm up before exercising or doing any physical activity.
  • Maintain proper strength by exercising the quadriceps, calf muscles, and hamstring muscles.
  • Use proper footwear for your sport. You may need orthotic support to help correct misalignment.
  • Slowly increase activity to avoid stress on the knee.
  • Use proper form and technique for any sport.

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RESOURCES

American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org

OrthoInfo—American Academy of Orthopaedic Surgeons
http://orthoinfo.org

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org

Canadian Orthopaedic Foundation
http://www.canorth.org

References

Harris JD, Siston RA, Pan X, Flanigan DC. Autologous chondrocyte implantation: a systematic review. J Bone Joint Surg Am. 2010 Sep 15;92(12):2220-2233.

Knee pain. Merck Manual for Health Care Professionals website. Available at: http://www.merckmanuals.com/professional/injuries%5Fpoisoning/sports%5Finjury/knee%5Fpain.html. Updated October 2014. Accessed March 3, 2015.

Patellofemoral pain syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 24, 2014. Accessed March 3, 2015.

Patellofemoral pain syndrome (runner's knee). John Hopkins Medicine website. Available at: http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/mens%5Fhealth/patellofemoral%5Fpain%5Fsyndrome%5Frunners%5Fknee%5F85,P07841/. Accessed March 3, 2015.

Runner's knee (patellofemoral pain). American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00382. Updated February 2015. Accessed March 3, 2015.

Pihlajamäki HK, Kuikka PI, Leppänen VV, Kiuru MJ, Mattila VM. Reliability ofclinical findings and magnetic resonance imaging for the diagnosis of chondromalacia patellae. J Bone Joint Surg Am. 2010 Apr;92(4):927-934.

Vasiliadis HS, Wasiak J, Salanti G. Autologous chondrocyte implantation forthe treatment of cartilage lesions of the knee: a systematic review of randomized studies. Knee Surg Sports Traumatol Arthrosc. 2010 Dec;18(12):1645-1655.

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