Chondromalacia patellae is damage to the cartilage at the back of the kneecap (patella). The common treatment advised is to avoid overuse of the knee and to have physiotherapy which, in most cases, is effective.
What is the Patella?
The patella (kneecap bone) lies within the quadriceps tendon. This large tendon from the powerful thigh muscles (quadriceps) wraps around the patella and inserts into the top of the lower leg bone (tibia). The quadriceps muscles works to straighten the leg.
The back of the patella is covered with smooth cartilage. This helps the patella to glide over the lower part of the thigh bone (femur) when you straighten your leg.
What is Chondromalacia Patellae?
Chondromalacia Patellae is damage to the patella cartilage. It refers to the softening or wear and tear of the cartilage. It ranges from slight to sever roughening or damage.
Chondromalacia Patellae overlaps with the knee condition known as patellofemoral pain syndrome. This term is used by doctors to describe the pain at the front of the knee, which may arise from various causes, but does not seem to be due to a severe problem such as severe arthritis or an injury.
What causes chondromalacia patellae?
Chondromalacia patellae occurs most often in young adults and teenagers. It is also more commonly faced by women. The reason why this damage occurs to the cartilage is unclear. It is said that the patella may rub against the lower part of the thigh bone (femur) instead of gliding smoothly over. This may cause damage to the patellar cartilage. Some situations where this is more likely includes:
Overuse of the knee, such as during sporting activities.
Some individuals may have a slight problem with the alignment of their knee. This may result in the patella rubbing on, rather than glide over, the lower femur. It may be due to how the knee has developed over time. It may also be due to an imbalance in the muscles around the knee – for example, the large quadriceps muscle above the knee. If one side of the quadriceps muscles pulls harder than the other side, then the patella may not glide properly and rub on one side.
A combination of alignment problems (as above) and overuse due to sports, is the most common reason for getting chondromalacia patellae.
Injury to the knee is also a contributing factor – repeated small injuries or constant stress on the knee from sports, or due to slack ligaments (hypermobile joints).
In older people, it may develop as part of the ageing process where there is wear and tear of cartilage in many joints.
What are the symptoms of Condromalacia Patella?
- Pain around the knee. The pain is usually felt at the front of the knee, around or behind the kneecap. The pain will worsen when using the stairs. It may be brought on by sitting (with the knees bent) for long periods.
- A grating or grinding feeling or noise when the knee moves (crepitus).
- On rare occasions, some fluid swelling (effusion) of the knee joint.
How is Condromalacia Patella diagnosed?
Usually, a provisional diagnosis is made from your symptoms plus a doctor’s examination of the knee. This will be a working diagnosis rather than a definite one, because the cartilage cannot be seen without further tests (see below). In this situation, where there is no proof of chondromalacia, some doctors call the pain patellofemoral pain syndrome or anterior knee pain. There will be not much difference as the treatment will be the same from this point (see below).
Are any tests needed?
If required, tests may be used either to confirm the diagnosis or to rule out other causes. For example, if the diagnosis is not clear or if symptoms do not improve after treatment.
These tests includes:
- Blood tests and/or a standard knee X-ray – these may help to rule out some types of arthritis or inflammation
- MRI scan – shows details of the knee joint and can show up many cases of chondromalacia
- Arthroscopy – a tiny flexible camera is inserted into the knee to see exactly what the cartilage looks like. This requires an anaesthetic and has a small risk of complications
What are the treatment options for Condromalacia Patella?
- Avoid strenuous use of the knee – until the pain subsides. Symptoms usually improve in time if the knee is not overused
- Painkillers – paracetamol or anti-inflammatory painkillers such as ibuprofen can be consumed to ease the pain
- Physiotherapy – improving the strength of the muscles around the knee will ease the stress placed upon the knee. Also, certain specific exercises may help to correct problems with alignment and muscle balance around the knee
- Taping of the patella – is a possible treatment which can reduce pain. Adhesive tape is applied over the patella, to alter the alignment or the way the patella moves. Some people find this helpful. Some physiotherapists can offer patellar taping treatment
Surgery is not usually needed, but it may be required if the above treatments have not made any improvements. Arthroscopic surgery is the usual choice of operation. A tiny flexible camera is inserted into the knee to get a clearer view. The surgeon sees the inside of the knee joint and the cartilage, and will then operate through the camera tube. Possible surgical treatments include:
- The tight ligaments at the side of the patella are cut to allow the patella to better align itself, and move more smoothly.
- Smoothing or shaving of the cartilage that is located behind the patella.
- It all else fails, the patella will be removed as the knee can still function without it.