by Alan R

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:

Acute Care

Rest
Your knee will need time to heal. Avoid activities that place extra stress on your knee:
  • Do not do activities that cause pain. This includes running, jumping, and weight lifting using the leg muscles.
  • If normal walking hurts, shorten your stride.
  • Do not play sports until your doctor has said it is safe to do so.
Cold
Apply an ice or a cold pack to the area for 15-20 minutes, four times a day, for several days after the injury. Do not apply the ice directly to your skin. Wrap the ice or cold pack in a towel.
Pain Relief Medications
To manage pain, your doctor may advise:
  • Over-the-counter medication, such as ibuprofen or acetaminophen
  • Topical pain medication—creams or patches that are applied to the skin to help with soft tissue pain
  • Prescription pain relievers
Compression
Compression can help prevent more swelling. Your doctor may advise an elastic compression bandage around your knee. Be careful not to wrap the bandage too tight.
After treatment, you may need an elastic knee sleeve with the kneecap cut out to help support the knee joint.
Elevation
Elevation can also help keep swelling down. Keep your knee higher than your heart as much as possible.
Physical Therapy
You may be referred to a physical therapist. You will be taught exercises to help reduce discomfort and to strengthen the muscles in your leg.

Surgery

In most cases, surgery is not needed. But for some patients who have continued pain, surgery may performed. 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.

RESOURCES

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

American Orthopaedic Society for Sports Medicine http://www.sportsmed.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 2013. Accessed February 28, 2014.

Patellofemoral pain syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 10, 2013. Accessed February 28, 2014.

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 February 28, 2014.

Runner's knee (patellofemoral pain). American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00382. Updated August 2007. Accessed February 28, 2014.

Pihlajamäki HK, Kuikka PI, Leppänen VV, Kiuru MJ, Mattila VM. Reliability of clinical 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 for the 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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