Chondromalacia Patella

Chondromalacia Patella is a condition where the articular cartilage of your knee is either damaged or worn away.

Articular cartilage is a special type of cartilage which lines the bones of joints. It provides a smooth glistening surface that allows joints to move smoothly.

Diagram of the Anatomy of the Knee

Symptoms

Signs and symptoms of patellofemoral pain include:

  • A dull, achy pain in the front of your knee
  • Increased pain when you walk up or down stairs (the most common symptom)
  • Pain in your knee when kneeling or squatting
  • Knee pain after sitting for long periods of time
  • A grating or grinding sensation when you extend your knee
  • Knee stiffness

When to see your doctor

If the knee pain isn’t severe or disabling, treat it yourself with rest and cold packs. If the pain doesn’t improve within a few days, consult your doctor.

Seek medical care immediately if:

  • Your knee hurts and doesn’t function properly after an injury
  • Your knee hurts, even when you’re not putting weight on it
  • You have knee pain after a popping sound or snapping sensation
  • Your knee locks rigidly in one position, or your kneecap is visibly out of place
  • Your knee seems unusually loose or unstable when you put weight on it
  • Your knee is swollen
  • The pain is associated with fever, chills or redness around the joint

Causes

In adolescents and young adults, patellofemoral pain often is caused by muscle weakness, overuse or injury. Sometimes an unusual alignment of the kneecap is responsible. For older adults, patellofemoral pain may be related to arthritis of the knee joint — which causes cartilage to lose its normal shock-absorbing ability. Weak thigh and hip muscles or flat feet also may contribute to the pain. Even something as simple as worn-out or ill-fitting shoes can contribute to patellofemoral pain. It is more common in females, runners who are knock-kneed or flat-footed, and also more commonly occurs in people who have previously had a dislocation or fracture of the kneecap.

Risk Factors

The risk factors are pretty much the same as the causes of Chondromalacia Patella.
The risk factors for developing patellofemoral pain include:

  • Weakness of hip muscles, especially the muscles on the outside of the hip (hip abductors)
  • Malalignment of the lower extremity
  • Being knock-kneed or flat-footed
  • Trauma to the kneecap, such as a dislocation or fracture
  • The persons age; it mainly affects adults and adolescents. It is rare in the elderly population.
  • Wearing worn-out shoes or shoes that don’t fit properly
  • Women are twice as likely to develop it as compared to men
  • Certain sports which involve running or jumping can predispose to this condition

Investigations

Diagnosis is based primarily on your symptoms and a physical exam. Nevertheless, your doctor may recommend X-rays or other imaging tests, such as an MRI or CT scan, to help find out the cause of your knee pain. If your symptoms are severe, a minor surgical procedure known as arthroscopy may be helpful in treating this condition.

Complications

Patellofemoral pain can cause difficulty doing everyday activities, such as squatting down to pick something up and even just climbing stairs.

Treatment

Treatment of patellofemoral pain often begins with simple measures:

  • Resting you knee
  • Avoidance of activities that increase the pain, such as climbing stairs.
  • If needed, take pain relievers such as paracetamol or nonsteroidal anti-inflammatory pain relievers, such as aspirin or ibuprofen .

Exercises and therapy

To promote your recovery, your doctor may recommend specific exercises or physiotherapy to strengthen the muscles that support your knees and control limb alignment, such as your quadriceps, hamstrings and the muscles around your hips (especially the hip abductors). In other cases, knee braces or arch supports may be recommended.

When you exercise, choose activities that go easy on your knees, such as bicycling and swimming. Your physiotherapist may show you how to tape your knee to reduce pain and enhance your ability to exercise. You may be able to return to activities such as running, but you may need to reduce the number of miles you run until it doesn’t hurt during or after exercise. Icing after exercise may be especially helpful.

Don’t rush back to activity. It can take six weeks or more before you begin to feel better.

Types of surgery

If any of the above options prove ineffective, surgery can be done. However, this is only in rare circumstances.

  • Arthroscopy: This procedure involves the doctor putting a thin tube into your knee with a camera on the end (an arthroscope) through a small incision in your knee. Surgical instruments are passed through the arthroscope to remove pieces of damaged cartilage.
  • Realignment: Sometimes, in very difficult cases, the surgeon may need to correct the angle of your kneecap or relieve pressure on the cartilage in your knee by operating directly on the knee joint.

Seeking Advice

Your Family Doctor (GP)

Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to

  • tell you about your problem
  • advise you of the best treatment methods
  • prescribe you medications
  • and if necessary, refer you to Specialists (Consultants) for further treatment

You’re likely to start by first seeing your family doctor (GP). However, in some cases, you may be referred to a physiotherapist, an orthopaedic surgeon or a sports medicine specialist.

Because appointments can be brief, and because there’s often a lot of ground to cover, it’s a good idea to be well prepared for your appointment. Here’s some information to help you get ready for your appointment, and what to expect from your doctor.

Bring along information about yourself

It can be a great help for your doctor if you bring along the following information about yourself

  • A list of your medications, including the name and dosage.
  • Information about your medical problems and past treatment
  • Previous investigation results, such as xrays and blood tests.

Prepare a list of questions for your doctor

  • Write down any symptoms you’re experiencing, even any that seem to be unrelated may be important.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, as well as any vitamins or supplements, that you’re taking.
  • Take copies of any imaging tests you’ve had done, such as an X-ray, MRI or CT scan, or arrange to have these test results sent to your doctor before the appointment. Ask your doctor’s staff the best way to do this when making your appointment.
  • Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For patellofemoral pain, some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • Are they any other possible causes?
  • Do I need any special tests or investigations? How do I prepare for these tests?
  • Is my condition likely temporary or chronic?
  • What are my treatment options?
  • What is the best course of action?
  • Are there any alternatives to the primary approach that you’re suggesting?
  • Are there any restrictions on activity that I need to follow?
  • How long do I need to restrict activity?
  • Are there any exercises I can do at home that might help?
  • Is there anything else I can do that will help ease my symptoms?
  • Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
  • Are there any fact sheets or printed information that I can take home with me to read?Are there any reliable websites that I can visit?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask questions if don’t understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous, or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

The first thing you need to do is rest, and stop participating in any activity that causes you pain. Applying ice to the injured area and elevating your knee may help. If needed, take paracetamol or nonsteroidal anti-inflammatory pain relievers, such as aspirin or ibuprofen , until you can get in to see your doctor.

Prevention

Sometimes knee pain just happens. But certain steps may help prevent the pain.

  • Strengthen your muscles: Strong quadriceps and hip abductor muscles help keep your knee balanced during activity.
  • Use proper technique: Ask your doctor or physiotherapist about flexibility and strength exercises to optimize your technique for jumping, running and pivoting, in other words things to help the patella track properly in its groove. It is very important to exercise and strengthen your outer hip muscles to prevent your knee from caving inward when you squat down or step down from a step.
  • Maintain a healthy weight: If you’re overweight, losing the extra weight relieves stress on your knees.
  • Warm up and stretch: Before doing any form of exercise, warm up with five minutes or so of light activity and also stretch to make yourself more flexible..
  • Increase intensity gradually: Avoid sudden changes in the intensity of your workouts and instead work up to it over time.
  • Footwear: Make sure you have shoes that fit well and give good shock absorption. Think about getting shoe inserts if you are flat-footed.

It’s also important to listen to your body. If your knee hurts, stop what you’re doing. Pushing yourself may only lead to injury.

F.A.Q. | Frequently Asked Questions

What does surgery for Chondromalacia patella actually involve?
If there is a defined lesion found, then there are several options for treating the damaged cartilage, from smoothing it to stimulating cartilage repair.

I am a runner who has recently been diagnosed with Chondromalacia, I want to continue my running, am I hastening the deterioration of my knee joint? Do I need to stop running altogether?
Modification of activities is the first step in treatment, along with over the counter anti-inflammatory medications. You should modify your running to below your pain threshold. If you continue to press your training, you risk injuring the knee further. Sometimes, after the resolution of symptoms, the amount of running can be slowly increased back to your baseline. But be sure to avoid the pain as this indicates further injury and trauma to your knee.

If you have it in one knee will the other be affected by it?
No, the other may not be affected. This condition is common among athletes( runners; cyclists etc) , those who have either flat- feet or knock-knees.

Is there anything good you can do for this condition besides exercises?
Bracing it may be an option to consider but you should consult your doctor as well and also maybe a physical therapist (sometimes they can help with devices like this) to see what they say.