Chondromalacia patellae literally means “soft cartilage under the kneecap”; it is the technical term for a painful knee condition that causes irritated cartilage under the knee and a soft or deformed patella. This condition is also known as “runner’s knee” and occurs mostly in young athletes, but it is also seen frequently in older adults with arthritis — anyone can experience a knee injury. The resulting pain is the result of the femur and patella rubbing together.

Risk Factors

Risk factors for developing Chondromalacia patella include partaking in activities that involve abnormal knee cap positioning, weakness, or tightness of muscles around the knee, and excessive activity or sports involving joints in the knees. An imbalance in the muscles on the outside and inside of the thigh or trauma to the knee and surrounding areas can also pull the kneecap out of alignment.

Symptoms

The most common symptom of Chondromalacia patella is a grinding feeling when flexing the knee. This usually happens during activities such as knee bends, going down stairs, standing up after a long period, of sitting or running downhill. Pain is described as dull or aching and is felt behind, below, or on the sides of the kneecap. Pain can also become sharper and more intense during use of the knee.

Structure

The patella sits over the front of the knee joint. In a healthy joint, the back of the patella slides over a cartilage layer on the end of the femur. Ligaments and tendons connect the patella to the shinbone and thigh muscles. A problem in any of these bones or tissues can cause misalignment, leading to the patella rubbing directly against the femur or the sides of the joint.

High-Risk Sports

High-risk sports associated with Chondromalacia patella include football, cycling, tennis, rowing, ballet, weightlifting, gymnastics, snowboarding, water-skiing, running, and equestrian events. Any sport that involves running, squatting, jumping, and landing can result in this condition. People who sustain acute injuries during one of these activities should rest the limb for two or three days and use ice on the knee to alleviate swelling.

Nonsurgical Intervention

Nonsurgical treatment for people who are not athletes or engaged in sport includes nonsteroidal anti-inflammatory drugs to relieve pain and swelling, in combination with other painkillers or comfort measures. A medical professional may recommend an exercise program to strengthen muscles around the knee. Injured individuals should avoid high-impact exercises, kneeling, and squatting. A brace, knee tape, or patellar-tracking sleeve can provide a physical framework to help the kneecap stay in correct alignment while it heals.

Physiotherapy for Acute Injury

Physiotherapists primarily aim to reduce inflammation in athletes following a knee injury, and also to aid the body’s healing process and avoid joint stiffness or tight muscles that could contribute to another injury. Ice, heat, ultrasound treatments, TENS machines, electrotherapy, and magnetic field therapy can all provide pain relief.

Surgical Intervention

If the injury is severe, Chondromalacia patella reaches an advanced stage, or pieces of bone or cartilage end up in the synovial fluid, patients may require surgery. The surgeon will remove damaged cartilage and fragments from the joint cavity, leaving healthy cartilage in place. Surgery often enables doctors to correct kneecap alignment, but physical therapy or braces must maintain this correction. Sometimes tight ligaments are responsible for Chondromalacia patella, and surgical removal of those ligaments has excellent results. The prognosis after surgery for most people is very good, especially with physical therapy and adherence to medical advice.

Avoiding Injury

Athletes and other adults can minimize their risk of developing Chondromalacia patella. The first and most important recommendation is to avoid repeated stress on kneecaps. Wear kneepads if kneeling is unavoidable. Exercises to strengthen quadriceps, hamstrings, abductor, and adductor muscles can increase muscle balance to lower the risk of injury. Shoe inserts for those with flat feet may increase the arch of the foot to reduce pressure on the knees and improve kneecap alignment. It is also beneficial to maintain a healthy weight; extra weight means extra stress on knees during everyday activities.

Diagnosing Chondromalacia Patella

If the condition is suspected, a doctor will observe the alignment of the patella with the thigh bone. Resistive pressure on an extended kneecap helps judge swelling and tenderness around the knee. X-rays identify bone damage, misalignment, or arthritis. An MRI scan views cartilage wear and tear, and in some cases, the doctor may conduct an arthroscopic exam by inserting an endoscope and camera into the knee joint. Aspirating synovial fluid through a needle can also help medical professionals find inflammation, infection, or injury.

Grading

Chondromalacia patella has four diagnostic grades indicating severity.

• One: softened cartilage is present in or around the knee.
• Two: soft cartilage with an abnormal surface.
• Three: thinning cartilage, active deterioration and the start of tissue erosion.
• Four: the most severe; bone is exposed because much of the cartilage is gone and the bones are rubbing together in the knee joint.