Chondromalacia patella is one of the causes of patellofemoral pain syndrome (PFPS), or pain around the kneecap. Often called "Runner's Knee," this condition often affects young, otherwise healthy individuals.
The exact source of pain in these patients with chondromalacia is a subject of debate. Traditionally, people have thought that the pain is a result of irritation of the cartilage on the back of the kneecap. As the kneecap moves up and down, unevenly applied forces were thought to cause irritation to the cartilage. The problem is that cartilage is essentially free of any nerve endings--you can't feel your cartilage. Others believe the pain is the result of irritation to the soft-tissues surrounding the kneecap.
What we do know is that many people with this condition have similar examination findings, and a similar appearance of the cartilage when see during surgery. The cartilage in people with chondromalacia is often characterized by blistering, fissuring, and fraying of the normally smooth cartilage surface. In some more severe cases, the cartilage may become thin, giving the appearance of early arthritis of the knee.
Causes of Chondromalacia
Chondromalacia is interesting in that it often affects young, otherwise healthy, athletic individuals. Women are more commonly diagnosed with chondromalacia. Exactly why this is the case is unknown, but it is thought to have to do with anatomical differences between men and women, in which women experience increased lateral forces on the patella.
There are many causes of anterior knee pain, or pain around the kneecap, some of the more common include:
Patients should be evaluated by someone who is knowledgeable of these different diagnoses as an accurate diagnosis can help guide optimal treatment.
Treatment of Chondromalacia
The treatment of chondromalacia remains controversial, but most individuals can undergo effective treatment by resting the knee and adhering to a proper physical therapy program. Allowing the inflammation of chondromalacia to settle is the first step of treatment. Avoiding painful activities that irritate the knee for several weeks, followed by a gradual return to athletic activity is always the first step in treatment.
Low-impact, cross-training activities, such as swimming and bicycling, can allow an athlete to maintain their fitness while resting the knee joint. The next step in treatment is a physical therapy program that should emphasize strengthening and flexibility of the muscles of the hips and thighs. Older methods of therapy focused on the quadriceps in isolation, but more recent research has demonstrated the importance of the entire lower extremity and core muscles in addressing proper knee mechanics.
Treatment with surgery used to be common, but is much less likely to be needed as doctors have learned more about this condition. With proper rehabilitation, most patients find good treatment results without surgery, and the small number of patients who actually benefit from surgical treatment is small.
Historically, the surgical procedure called a a lateral release was performed for many people with symptoms of patellofemoral pain. We know that the actual group of patients who benefit from this procedure is small, and doctors have learned how to appropriately predict which patients might need this type of surgery. Arthroscopic surgery can be helpful for treatment of more severe cartilage damage, and it can also help treat conditions that may be seen in patients with chondromalacia such as plica syndrome and patellar subluxation.