Chondromalacia Patella – Presentation and Treatment

Last Updated on October 27, 2023

Chondromalacia patella is a condition characterized by softening and degeneration of the patellar articular cartilage. Chondromalacia patella is a term sometimes considered synonymous with patellofemoral pain syndrome but patellofemoral pain syndrome is a term that applies only to individuals without cartilage damage.

Chondromalacia patella is considered the most common cause of chronic knee pain.

Cartilage under patella or kneecap acts as natural shock absorber. Overuse, injury, and many other factors can cause increased deterioration and breakdown of the cartilage.

Chondromalacia is common among young, athletic individuals, but may also occur in older adults who have arthritis of the knee. There is a female predilection.

Causes of Chondromalacia Patella

The patella is normally pulled over the end of the femur in a straight line by the quadriceps muscle. Patients with chondromalacia patella frequently have abnormal patellar tracking toward the lateral side of the femur causing femur to grate on and cause chronic inflammation and pain. Abnormal patellar movement occurs due to improper working of bones, tendons or ligaments.

The general causes are

Risk Factors for Chondromalacia patella

Age

Adolescents and young adults are at high risk as during growth spurts, the muscles and bones develop rapidly which may cause short-term muscle imbalances.

Flat Feet

Flat feet puts higher stress on knee joints.

Trauma

A prior injury like dislocation or subluxation of patella can increase risk of chondromalacia patella.

Chronic friction between the patella and femoral groove can also result in this.

Activity

High-activity level or that places pressure on your knee joints, this can increase the risk for knee problems.

Knee Pathologies

Inflammation as in arthritis can prevent the kneecap from functioning properly. Other conditions of the knee which can cause chondromalacia patella is patella alta [high riding patella] quadriceps imbalance, weak hamstrings, congenital abnormalities, patellar maltracking, synovial plicae, tight iliotibial band, neuromas, bursitis etc.

Overuse

Persons engaging in soccer, gymnastics, cycling, rowing, tennis, ballet, basketball, volleyball, running, combat sports, snowboarding, skateboarding and even swimming are at increased risk.

Clinical Presentation of Chondromalacia Patella

Chondromalacia patella is suspected in a person with anterior knee pain, especially in teenage females or young adults.

Patients with chondromalacia patellae usually present with anterior knee pain or vague discomfort of the inner side of the knee, aggravated by activity (running, jumping, climbing or descending stairs) or by prolonged sitting. There may be knee pain when kneeling or squatting or after sitting for long periods of time.

The patient may also complain of knee stiffness or tightness. The examination may reveal mild swelling of the knee.

Imaging

Plain radiographs of the knee cannot assess for cartilage changes and can only show bony changes if present e.g. that of osteoarthritis.

MRI is the modality of choice for assessing patellar cartilage and is able to display cartilage abnormalities.

Grading of Chondromalacia Patella

Grade I

Softening of the cartilage in the knee area.

Grade II

Softening of the cartilage along with abnormal surface characteristics. This usually indicates the beginning of tissue erosion.

Grade III

Thinning of cartilage with the active deterioration of the tissue.

Grade IV

Significant cartilage loss with bone exposure

Differential Diagnosis

Treatment of Chondromalacia Patella

RICE therapy
Curtailing the activities
NSAIDs
Exercises
- Stretch and strengthen quadriceps especially vastus medialis
- Cardiovascular conditioning
  - stationary bicycling
  - swimming
- Proper training schedule
- Proper footwear

With proper treatment, the patient generally return to full functional level.

Surgical options may be needed when the imbalance is severe or the patient does not show improvement, surgical options may be considered

Arthroscopic debridement and lavage
Articular resurfacing
Instability correction
Patellectomy

Prevention

Avoid repeated stress to your kneecaps.
Use knee pads
Quadriceps and hamstrings strengthening exercises, as well as your abductors and adductors.
Wear shoe inserts that correct flat feet
Maintain proper weight

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Swimmer’s Shoulder Causes, Symptoms and Treatment

Swimmer’s shoulder is an umbrella term covering a range of painful shoulder in the competitive swimmer lead to a spectrum of overuse injuries seen in the swimmer’s shoulder, the most common of which is rotator cuff tendinitis. Shoulder pain is the most common musculoskeletal complaint in swimming with swimmer’s shoulder. Reports of incidence of disabling shoulder pain […]

Distal clavicle Osteolysis Symptoms, Diagnosis and Treatment

Distal clavicle osteolysis refers to the process causing resorption of subchondral bone in the distal clavicle [lateral calvicle], often caused by repetitive strain injury and microfracture, and presenting as pain in the acromioclavicular joint. Distal clavicle osteolysis was first described in 1936. Distal clavicle osteolysis is believed to be an underreported and underdiagnosed condition. More […]

Orthobiologics – Types and Uses

Orthobiologics Definition Orthobiologics are biological substances that are used to help injuries to heal more quickly. Orthobiologics are used to improve the healing of fractures, injured muscles, tendons and ligaments. Orthobiologics are made from substances that naturally occur in the body. When they are used in higher concentrations, they may help to hasten the healing […]

Synovectomy Knee – Indications and Procedure

Synovectomy knee is a surgery where synovium of the knee joint is removed surgically. Synovectomy of knee classically was done with open incision but with increasing success of arthroscopic synovectomy, arthroscopic synovectomy of knee offers an option where there is minimal soft tissue trauma. The goal in synovectomy is total synovectomy which means complete removal […]

Congenital Dislocation of Radial Head

Congenital radial head dislocation is an unusual congenital dislocation in which there is dislocation of the radial head from its usual position. The direction of the displacement of the radial head may be anterior or posterior or lateral. Congenital radial head dislocation is a rare congenital abnormality of the elbow though statistically most common one. […]

Neck Pain Causes and Treatment

Neck pain is almost as common a complaint as low back pain. Most cases of neck pain are due to minor muscular or ligament stresses. But there could be many other causes including the serious ones. Most of the neck pain cases are short-lasting and often can be managed at home. But a chronic pain […]

Iliotibial Band Anatomy

The iliotibial band is also called iliotibial tract and is a wide sheath of fibrous tissue that surrounds muscles on the lateral aspect of the thigh. It connects hip muscles to the tibia and plays an important part in thigh motion. Origin, Course, and Insertion of Iliotibial Band The iliotibial band is actually a thickening […]